2019 JSNA Final

Stoke-on-Trent
Joint Strategic Needs Assessment

2019
CONTENTS
1 SUMMARY ........................................................................................................... 4
2 INTRODUCTION ................................................................................................... 14
2.1 Health and wellbeing vision ..................................................................................... 14
3 SOCIAL DETERMINANTS OF HEALTH .................................................................... 15
4 POPULATION PROFILE ......................................................................................... 16
5 OVERARCHING MEASURES OF HEALTH ................................................................ 19
5.1 Life expectancy ........................................................................................................ 19
5.2 Healthy life expectancy ............................................................................................. 20
5.3 Health literacy .......................................................................................................... 20
6 BEST START IN LIFE – FROM BIRTH TO AGE FIVE ................................................... 21
6.1 Children in poverty ................................................................................................... 23
6.2 Low birthweight babies ............................................................................................ 24
6.3 Infant mortality ......................................................................................................... 25
6.4 Smoking during pregnancy ....................................................................................... 26
6.5 Breastfeeding ........................................................................................................... 26
6.6 Vaccination coverage ................................................................................................ 27
6.7 Tooth decay .............................................................................................................. 28
6.8 School readiness ...................................................................................................... 28
7 DEVELOPING WELL – CHILDHOOD INTO YOUNG ADULTHOOD ............................... 29
7.1 School characteristics .............................................................................................. 31
7.2 Learning disabilities ................................................................................................. 31
7.2 Pupil absence ........................................................................................................... 31
7.4 School attainment .................................................................................................... 31
7.5 Not in education, employment or training ................................................................. 32
7.6 Children’s weight ...................................................................................................... 32
7.7 Smoking, alcohol and drug use ................................................................................. 33
7.8 Referrals to children’s social care ............................................................................. 33
7.9 Children’s safeguarding ............................................................................................ 33
7.10 Wellbeing of pupils ................................................................................................... 33
7.11 Wellbeing of looked after children ............................................................................ 34
7.12 Wellbeing of all children ........................................................................................... 34
7.13 Self-harm ................................................................................................................. 35
7.14 Unintentional and deliberate injuries ........................................................................ 36
7.15 Hospital admissions for asthma, diabetes or epilepsy ............................................... 38
7.16 Teenage pregnancy .................................................................................................. 39
7.17 First time entrants to the Youth Justice System ......................................................... 40
7.18 Reoffending .............................................................................................................. 40
7.19 Road traffic accidents ............................................................................................... 40
2.
8 LIVING WELL – WORKING AGE ADULTS ................................................................. 41
8.1 Burden of disease ..................................................................................................... 44
8.2 Major killers .............................................................................................................. 44
8.3 Preventable mortality ............................................................................................... 44
8.4 Premature mortality (under 75) ................................................................................ 45
8.5 Wellbeing ................................................................................................................. 48
8.6 Mental health conditions .......................................................................................... 49
8.7 Suicides .................................................................................................................... 50
8.8 Intentional self-harm ................................................................................................ 51
8.9 Learning disabilities ................................................................................................. 51
8.10 Smoking ................................................................................................................... 52
8.11 Excess weight ........................................................................................................... 53
8.12 Healthy eating .......................................................................................................... 53
8.13 Physical activity ........................................................................................................ 54
8.14 Alcohol ..................................................................................................................... 55
8.15 Drugs ........................................................................................................................ 55
8.16 NHS Health Checks ................................................................................................... 56
8.17 Qualifications and skills ............................................................................................ 57
8.18 Crime and violence ................................................................................................... 57
8.19 Road traffic accidents ............................................................................................... 58
9 AGEING WELL – HEALTHY OLDER PEOPLE ............................................................. 59
9.1 Future needs ............................................................................................................. 61
9.2 Long-term conditions ............................................................................................... 62
9.3 Social care outcomes ................................................................................................ 63
9.4 Loneliness ................................................................................................................ 64
9.5 Fuel poverty .............................................................................................................. 64
9.6 Pneumococcal and flu vaccinations ........................................................................... 65
9.7 Excess winter deaths ................................................................................................ 66
9.8 Falls and hip fractures .............................................................................................. 67
9.9 End of life .................................................................................................................. 68
10 CREATE FAIR EMPLOYMENT AND GOOD WORK FOR ALL ......................................... 69
10.1 Economy ................................................................................................................... 71
10.2 Employment ............................................................................................................. 71
10.3 A healthy workforce .................................................................................................. 72
11 ENSURE A HEALTHY STANDARD OF LIVING FOR ALL .............................................. 73
11.1 Income and wages .................................................................................................... 75
11.2 Employment ............................................................................................................. 75
12 CREATE AND DEVELOP HEALTHY AND SUSTAINABLE PLACES AND COMMUNITIES 76
12.1 Environment ............................................................................................................. 78
12.2 Satisfaction with local area ....................................................................................... 79
12.3 Housing .................................................................................................................... 80
12.4 Walking and cycling .................................................................................................. 80
12.5 Public transport ........................................................................................................ 80
12.6 Community action ..................................................................................................... 81
REFERENCES .................................................................................................................. 82
APPENDIX - MAIN FINDINGS ........................................................................................... 87
3.
1. SUMMARY
Whilst there have been improvements across a The JSNA brings together a range of key information
number of key health outcomes in Stoke-on-Trent in which broadly reflects the principles of the Marmot
recent years, the health of local people is generally Review1 These have been grouped into seven
worse than the England average. Life expectancy themes:
levels among men and women in Stoke-on-Trent
have stalled, whilst health outcomes across the city • Best start in life – from birth to age five
vary considerably. Men living in the most deprived • Developing well – childhood into young adulthood
areas of the city, for instance, live nearly 10 years less (5-19 year olds)
than men in the most affluent areas. For women, this • Living well – working age adults
gap is around 6.5 years. • Ageing well – older people (65 and over)
• Create fair employment and good work for all
This Joint Strategic Needs Assessment (JSNA) • Ensure a healthy standard of living for all
provides an assessment of the current and future • Create and develop healthy and sustainable
health and social care needs of people living in places and communities
Stoke-on-Trent.
A population profile and some overarching measures
of health have been included to give greater context
to these themes.
4.
POPULATION
255,378
people live in Stoke-on-Trent
20.3%
are children 0-15
Around
(51,790)
3,300
62.8% babies born a year
are aged 16-64
20.2%
(160,387)
16.9% are aged 65 and over

(43,201) of people are from
minority ethnic groups
14th most deprived local authority in England (out of 326)
136,221
people in the city live in the
top 20% most deprived areas
OVERARCHING MEASURES OF HEALTH

Average 76.5 years 79.6 years in England
likely to be spent
77.8% in good health 79.7% in England
Life expectancy in most deprived areas 9.6 years less
Average 80.8 years 83.1 years in England
likely to be spent
72.7% in good health 76.7% in England
Life expectancy in most deprived areas 6.4 years less
5.
BEST START IN LIFE – FROM BIRTH TO AGE FIVE
23.8%
of children (under 16)
9.5%
of babies have a low
live in poverty (England 16.8%) birthweight (England 7.3%)
18.2%
of women smoke whilst
Breastfeeding rates
74.5%
pregnant (England 10.8%)
60.1%
Highest infant
mortality in England 42.7%
27.1%
one baby dies every

Initiation Week 6-8
two weeks locally Stoke-on-Trent England Stoke-on-Trent England
32.6%
of five years old have tooth
Over
90%
of children vaccinated for main illnesses
decay (England 23.3%) (better than England)
6.
DEVELOPING WELL – CHILDHOOD INTO
YOUNG ADULTHOOD
40,027 schoolchildren
7,952 have free school meals
2,523 have a learning disability
58% of Key Stage 2 pupils (10-11 year olds)

meet expected standards (England 65%)
53.3%
of Key Stage 4 pupils (15-16 year olds)
achieved a 9-4 pass including English
and maths (England 59.1%)
19.2%
Healthy
Healthy
of Reception pupils (4-5 year olds)
are overweight or obese (England 22.4%)
37.1%
of Year 6 pupils (10-11 year olds) are
overweight or obese (England 34.3%)
12.8% Teenage pregnancies

(15-17 year olds) have fallen
47%
of 5-19 year olds by
estimated to have a
mental health disorder
between 2012 and 2016
Hospital admissions for
self-harm getting worse
(10-24 year olds)
7.
LIVING WELL – WORKING AGE ADULTS
Around
2,500 deaths 24,674

Top 3 killers
a year
adults
(18-64) have a common
28.7% 23% 16.1%

3,758 adults
Cancer Circulatory Respiratory (18-64) with a learning disability
Disease Disease
9 smokers die
20.7% of adults (18+)
smoke each week
Healthy
Healthy
66.0%
of adults (18+) are
overweight or obese
45.2%
of adults (16+) do
54.1%
(19+)
30.9%
(19+)
not eat enough

fruit and veg Do enough Don’t do any
exercise exercise
8.
44.0%
of adults (18+)
are drinking at
dangerous levels
21.9%
of alcohol users
Deaths and hospital
admissions from alcohol
are higher than England:
successfully 3 drinkers die each week
complete treatment
(England 38.9%)
12.3%
of adults (16-64) have no
More people use qualifications (England 7.6%)
drugs in the city
23.4%
of adults are qualified to NVQ
level 4 and above (England 38.3%)
Around
30,000 recorded
crimes
– an increase of
9,500 since
2012/13
9.
AGEING WELL – HEALTHY OLDER PEOPLE
9,300
An extra
people aged 65 and
over by 2030
Increasing numbers of: limiting long-term illness,
dementia, depression, falls
7 out of 10
people (65+)
had a flu jab
3,595 requests for
956
support from new clients
(aged 65+) to Adult Social Care
emergency hospital admissions
due to falls
– an average of
10 a day
260 emergency admissions

for hip fractures
6 out of 10 people cared for by
38% of people
died at home
local carers are aged 65 and over
66.8%
(England 46.6%)
of service users were
39,000
people estimated
satisfied with the care and
support they received from
social services (England 65.0%)
10.
to be in fuel poverty
2.7% of service users did not
feel safe (England 1.8%)
CREATE FAIR EMPLOYMENT AND GOOD WORK
FOR ALL
71.6% of people (aged 16-64) are

working (England 75.2%)
29%
of people (16+) are working in
managerial and professional jobs
(England 46.5%)
6,600 19.5%
of households
people (16+)
are unemployed are ‘workless’
(England 14.0%)
11,000 people (aged 16-64) are economically

inactive due to long-term sickness
2.6% of workers had at least one day off work

due to sickness (England 2.1%)
11.
ENSURE A HEALTHY STANDARD OF LIVING FOR ALL
Average pay in the city is around
£100 lower
a week lower than the rest of England
20.8%
of people are experiencing
deprivation due to low incomes
(England 14.6%)
12,400 people
(aged 16-64) are underemployed
they would like to work more hours
16,400 people
(aged 16-64) are overemployed
they would like to work fewer hours
22% of children
(aged 0-15) live in out-of-work
benefit households (England 14.0%)
12.
CREATE AND DEVELOP HEALTHY AND
SUSTAINABLE PLACES AND COMMUNITIES
89% of people
were satisfied with the area as
a place to live
77% 23%
of people of people
feel safe outside after dark feel likely to be a victim of crime
Biggest problems locally
23% 21% 20%

Drugs Anti-social Alcohol
behaviour
778 households
on the Housing Register have a housing need
or urgent need
195 households
were accepted as being homeless
13.
2. INTRODUCTION
This Joint Strategic Needs Assessment (JSNA) 2.1 Health and wellbeing vision
provides an assessment of the current and future
health and social care needs of people living in Stoke- The city council’s Health and Wellbeing Strategy
on-Trent. The purpose of this JSNA is to help inform (2016-2020)2 is shaped by the JSNA. The strategy
the city council’s Health and Wellbeing Strategy, aims to help Stoke-on-Trent be:
and to enable local commissioners and a range of
organisations to plan and deliver services for the • A vibrant city where everyone will live, work and
future that will meet the needs of local people. play in a successful, attractive environment which
supports them to live healthy and fulfilling lives.
Although this JSNA does not provide any detailed
commissioning plans, standalone needs assessments • A healthy and successful city where children
or ‘deep dives’, it is essential that it informs the enjoy the best start in life and everyone will live
commissioning process. To aid this, this JSNA brings longer and healthier lives with equal access to
together a range of key information which broadly health and care services should they need them.
reflects the principles of the Marmot Review.1 These
have been grouped into seven themes: • A caring city where everyone is supported to live
independent lives with fair access to high quality,
• Best start in life – from birth to age five integrated health and social care services when
• Developing well – childhood into young adulthood needed.
(5-19 year olds)
• Living well – working age adults This JSNA is integral in helping drive this agenda
• Ageing well – older people (65 and over) forward, and helping to build on the vision for Stoke-
• Create fair employment and good work for all on-Trent to be a “vibrant, healthy and caring city
• Ensure a healthy standard of living for all which supports its citizens to live more fulfilling,
• Create and develop healthy and sustainable independent and healthy lives”.2
places and communities
To give greater context to these themes, two

additional areas have been included – a population
profile and some overarching measures of health.
14.
3. SOCIAL DETERMINANTS
OF HEALTH
The health and wellbeing of people across all ages is influenced by a range of factors (or determinants).
These social determinants of health refer to the daily conditions in which people are born, grow, live, work and
age. Genetic factors, lifestyle choices, the communities in which people live, education, employment, housing
and access to healthcare services are all examples of the social determinants of health (figure 1).3
Figure 1 Social determinants of health
mic , cultural and e

cono nvi
ron
-e m
cio en
so Living and working
conditions
ta
l
ra
lc
Unemployment
community n
Work
ne
on
environment
l a n etw
Ge
ia
dit
o
oc al lifestyle f Water
du ac
Education
ions
i
sanitation
rk
v to
S
di
s
rs
In
Health
care
services
Agriculture
and feed
production
Housing
Age, sex and

hereditary
factors
In helping to understand the health and wellbeing needs of people living in Stoke-on-Trent, the social
determinants of health approach has been adopted throughout this JSNA.
15.
4. POPULATION PROFILE
• There were an estimated 255,378 people living in • This increase in the local population has largely
Stoke-on-Trent in 2017 (figure 2).4 Over the past been the result of net international migration into
10 years, the local population has increased at a the city, with the largest increases being among
slower rate compared with England (4.8% versus children under five and young adults aged 20-35
8.2%). This lower increase locally is projected to years of age.6
continue over the next 10 years.5
Figure 2 2017 population estimates for Stoke-on-Trent

Age group
90+
Stoke-on-Trent
85-89
80-84
75-79
England
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
5 4 3 2 1 0 1 2 3 4 5
% of total population
Source: Office for National Statistics 2018
16.
• Around 43,200 people in Stoke-on-Trent are aged • Stoke-on-Trent is becoming an increasingly
65 years and over (which is a lower proportion ethnically diverse city, with the proportion of
than England – 16.9% compared with 18.0%).4 Of people from ‘Non-White British’ backgrounds
these, nearly 5,100 are aged 85 and over (2.0% of growing from 6.4% in 2001 to an estimated 20.2%
the population compared to 2.4% nationally).4 in 2016.10 This is an increase of around 35,500
people (from 15,500 to 51,000). This growth
• By 2030, the numbers of people aged 65 and over will likely have an impact on some long-term
in the city are projected to increase by around conditions such as diabetes and heart disease,
9,300, taking the number aged 65 and over up as well as the areas in which people live and the
to 52,400.5 This means that nearly 1 in 5 local types of employment provided and undertaken.
people (19.9%) will be aged 65 and over by 2030
(compared with 21.7% in England). • Locally, the largest increase in the ‘Non-White
British’ population between 2001 and 2016 has
• There were nearly 51,800 children (aged 0-15) been among people classified as ‘Other White’
in the city, which is a similar proportion (20.3%) (which consists mainly of people from the
compared with England (19.1%).4 By 2030, it European Union) – the number has increased
is projected that the numbers of 0 -15 year olds from around 3,000 to 11,000 over the past 15
locally will broadly remain the same.5 years. Nationally, the largest increase has been
among people from an ‘Asian’ background.
• In 2017, there were just under 3,300 live births in
Stoke-on-Trent, which is the lowest number there • Stoke-on-Trent is characterised by high levels
has been since 2010.7 Since 2010 the numbers of deprivation and is currently ranked the 14th
of live births to mothers aged under 25 years most deprived local authority (out of 326) in
has fallen in the city, but have increased among England (based on the 2015 Index of Multiple
women aged 25-44 years.8 This mirrors the Deprivation).11 The most deprived areas of the
national picture. city are located around the wards of Tunstall,
Burslem Central, Etruria and Hanley, Bentilee
• Stoke-on-Trent’s crude birth rate in 2017 was and Ubberley, and Blurton West and Newstead
marginally higher than England (12.9 per 1,000 (map 1 overleaf).
live births versus 11.6).9 The general fertility rate
(which takes account of the number of women • Over 136,200 people in the city live in areas
of child bearing age) was also higher locally classified as being among the top 20% most
compared with England (68.0 versus 61.2 per deprived in England, which is over 53% of the
1,000 live births to women aged 15-44).9 total population. This means that 5 out of every
10 people in Stoke-on-Trent are living in the most
• The percentage of deliveries to mothers from deprived areas of the country (compared with 2
Black and Minority Ethnic (BME) groups has out of 10 nationally).
increased locally from 19.4% in 2012/13 to nearly
one quarter (23.5%) in 2016/17 (which is similar
to the national average of 23.3%).7 This equates
to around 780 births to BME women in the city a
year.
17.
Map 1 2015 Index of Multiple Deprivation in Stoke-on-Trent
18.
5. OVERARCHING MEASURES
OF HEALTH
5.1 Life expectancy
Life expectancy is one of the key measures of a • Life expectancy among women in the city is 80.8
population’s health, and refers to the number of years years compared with 83.1 years in England.13 Life
a person can expect to live. Locally, the latest data expectancy has remained unchanged locally for
shows that: women since 2012-14. Life expectancy levels for
men and women in the city are significantlyi lower
• Life expectancy (at birth) for men in Stoke-on- than national averages.
Trent is 76.5 years compared with 79.6 in England
in 2015-17 (figure 3).12 Locally, life expectancy • Life expectancy is 9.6 years lower for men14 and
for men has remained unchanged since 2010-12. 6.4 years lower for women15 living in the most
deprived areas of Stoke-on-Trent compared with
those in the most affluent areas of the city.
Figure 3 Life expectancy (at birth) in Stoke-on-Trent (2001-03 to 2015-17)
84
82
80
78
Life expectancy (years)
*
76
74
72
70
Stoke - males
England - males
68
Stoke - females
England - females
66
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Source: Public Health England 2018 Year
* The vertical bars on the charts show the 95% confidence intervals (95% CI), and have been used to test whether there is a
statistically significant difference between Stoke-on-Trent and England. If the bars of the 95% CI overlap, then there is said to be no
difference (statistically) between areas. If the bars do not overlap, there is a significant difference (statistically) between areas.
i
Statistical tests have been used to see whether the differences between Stoke-on-Trent and England are the result of chance. A statistically
significant result happens when the test shows that the difference between Stoke-on-Trent and England is unlikely to be the result of chance.
19.
5.2 Healthy life expectancy 5.3 Health literacy
Improving life expectancy is not only about adding Health literacy is important when thinking about
years to life, it’s also about adding quality to life. the current and future health and social care needs
Healthy life expectancy (HLE) is an estimate of the of people living in Stoke-on-Trent. Health literacy
number of years someone would expect to live in refers, broadly, to the ability of people to ‘gain access
good health. to, understand and use information in ways which
promote and maintain good health’ for themselves,
• In Stoke-on-Trent (in 2015-17), healthy life their families and their communities.19
expectancy for men was 59.5 years compared
with 63.4 years in England.16 This means that Health literacy is not just a personal issue, and it is
77.8% of a man’s life in Stoke-on-Trent is likely important for health and social care providers to
to be spent in good health (compared with 79.7% ensure they present clear, accurate and accessible
nationally). information for a range of people.
• For women in the city, HLE was 58.7 years A local study undertaken in 2015 found that 49% of
(compared with 63.8 years in England).17 This adults in Stoke-on-Trent had inadequate levels of
means that 72.7% of a woman’s life in Stoke- health literacy.20
on-Trent is likely to be spent in good health
(compared with 76.7% in England).
• Although women in Stoke-on-Trent live longer

than men, a larger proportion of their lives are
spent in poorer health.
• Men and women living in the most deprived areas

of Stoke-on-Trent have a HLE which is around 13
years lower than those living in the most affluent
areas of the city.18
20.
6. BEST START IN LIFE –
FROM BIRTH TO AGE FIVE
21.
BEST START IN LIFE – FROM BIRTH TO AGE FIVE
23.8%
of children (under 16)
9.5%
of babies have a low
live in poverty (England 16.8%) birthweight (England 7.3%)
18.2%
of women smoke whilst
Breastfeeding rates
74.5%
pregnant (England 10.8%)
60.1%
Highest infant
mortality in England 42.7%
27.1%
one baby dies every

Initiation Week 6-8
two weeks locally Stoke-on-Trent England Stoke-on-Trent England
32.6%
of five years old have tooth
Over
90%
of children vaccinated for main illnesses
decay (England 23.3%) (better than England)
22.
6.1 Children in poverty
The Marmot Review1 suggests there is evidence • Levels of child poverty continue to reduce in
that childhood poverty leads to premature mortality Stoke-on-Trent, and the percentage of children
and poor health outcomes for adults. Reducing the under 16 living in poverty locally has fallen from
numbers of children who experience poverty should 29.6% in 2006 to 23.8% in 2015, the lowest for the
improve these adult health outcomes and increase past decade (figure 4).21
healthy life expectancy.
• Although this fall is encouraging, child poverty
levels locally remain significantly higher than the
England average of 16.8%, and around 12,400
local children are likely to be living in poverty
across the city.
Figure 4 Children (under 16) living in poverty in Stoke-on-Trent (2006-2015)

35
30
25
20
15
10
Stoke
England
5
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Year
Source: Public Health England 2018
23.
6.2 Low birthweight babies
Low birthweight increases the risk of childhood at 9.5% (compared with 7.3% in England, figure
morbidity and mortality and is associated with poorer 5).9 This is significantly higher than the England
health in later life. Babies weighing less than 2,500 proportion.
grams are considered to have a low birthweight.
• The proportion of full-term babies with a low
• The proportion of low birthweight babies (live birthweight in Stoke-on-Trent has increased
and stillbirths) has remained largely unchanged from 3.1% in 2010 to 3.9% in 2016.22 This remains
in Stoke-on-Trent since 2010 and currently stands significantly higher than the England proportion
of 2.8%.
Figure 5 Low birthweight of all babies and full-term babies* in Stoke-on-Trent (2010-2016)
12
10
Stoke - all
%6 England - all
Stoke - term
England - term
0
2010 2011 2012 2013 2014 2015 2016
Year
* All babies = live and stillbirths; full-term babies = live births >= 37 weeks
24.
6.3 Infant mortality
Infant mortality (deaths during the first year of life) • The current mortality rate is significantly higher
is an indicator of the general health of an entire locally compared with England.
population. It reflects the relationship between the
causes of infant mortality and the wider determinants • During 2015-17, 82 infants died in Stoke-on-Trent
of health such as economic, social and environmental during their first year of life. This means, that on
factors. average, one infant died every two weeks in the
city.
• The infant mortality rate continues to increase in
Stoke-on-Trent, and in 2015-17 the local rate was • Compared with other local authorities in England,
8.1 (per 1,000 live births) compared with 3.9 in the infant mortality rate in Stoke-on-Trent in
England (figure 6).23 2015-17 was ranked the highest in the country
(Birmingham was ranked second highest with a
• Locally, this is the highest the rate has been since rate of 7.8, whilst Sandwell was third highest with
2004-06. a rate of 6.5).23
Figure 6 Infant mortality rates in Stoke-on-Trent (2001-03 to 2015-17)

14
12
10
Crude rate per 1,000 live births
Stoke
England
2
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
25.
6.4 Smoking during pregnancy
Smoking whilst pregnant has detrimental effects • The proportion of women smoking during
on the growth and development of babies (such pregnancy in Stoke-on-Trent is the lowest it has
as low birthweight) and on the health of mothers. been in nearly a decade (figure 7). In 2017/18,
Smokers, on average, have more complications 18.2% of local women smoked during pregnancy
during pregnancy and labour, including bleeding compared with 10.8% in England.24
during pregnancy, placental abruption and premature
rupture of membranes. • In spite of the recent fall, the current proportion
of women smoking during pregnancy remains
significantly higher in Stoke-on-Trent compared
with England.
Figure 7 Smoking in pregnancy in Stoke-on-Trent (2010/11 to 2017/18)

30
25
20
15
10
Stoke
England
5
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Year
6.5 Breastfeeding
Breast milk provides the ideal nutrition for babies, • The proportion of women initiating breastfeeding
and has a range of health benefits to both mother (in the first 48 hours after delivery) has remained
and child. Babies who are breastfed are likely to largely unchanged in Stoke-on-Trent since
have lower levels of gastro-intestinal and respiratory 2010/11 and was 60.1% in 2016/17 (compared
infections, and lower levels of child obesity. Mothers with 74.5% in England).25 This is significantly
who do not breastfeed have an increased risk of lower than England.
breast and ovarian cancer and may find it more
difficult to return to their pre-pregnancy weight. • The proportion of mothers in Stoke-on-Trent who
continued to breastfeed at 6-8 weeks was 27.1%
in 2017/18, which was significantly lower than the
national average of 42.7%.26
26.
6.6 Vaccination coverage
• Childhood immunisation rates across Stoke-on- • However, immunisation rates in the city continue
Trent are generally high, with over 90% of local to fall. In 2015/16, 8 of the 9 main immunisation
children being immunised against the main health rates were above the recommended 95%
protection outcomes (figure 8).27 protective target set by the World Health
Organisation – in 2017/18, there were only three.
Figure 8 Childhood immunisations in Stoke-on-Trent (2017/18)

100
Stoke
98 England
WHO target
96
94
92
%
90
88
86
84
82
Dtap/IPV/Hib PCV Dtap/IPV/Hib MMR one Hib/MenC PCV booster Hib/MenC MMR one MMR two
dose booster booster dose doses
<---12 months ---> -------------------- 24 months --------------------
< > <-------------- 5 years -------------->
27.
6.7 Tooth decay
Tooth decay is mainly a preventable disease. • The 2012/13 dental survey for three year olds
However, significant levels of decay remain, resulting found that 7.1% of local children reported having
in pain, sleep loss, time off school, and in some cases, tooth decay (compared with 11.2% in England).29
treatment under general anaesthetic. This indicates that tooth decay among children
appears to increase significantly between the
• The latest 2016/17 dental survey for five year ages of three and five.
olds found that nearly one third of local children
(32.6%) were suffering from tooth decay (figure
9).28 In spite of a local fall since 2007/08, current
levels of tooth decay remain significantly higher
than the national average of 23.0%.
Figure 9 Tooth decay among five year olds in Stoke-on-Trent (2007/08 to 2016/17)
50
Stoke
England
45
40
35
30
%
25
20
15
10
0
2007/08 2011/12 2014/15 2016/17
Year
6.8 School readiness

• Among Reception children in Stoke-on-Trent who
• At the end of Reception (4-5 year olds), 66.1% of were eligible for free school meals, 55.9% had
schoolchildren in Stoke-on-Trent had achieved a achieved a good level of development and were
good level of development and were considered ‘ready for school’, similar to the national average
‘ready for school’ (in 2016/17). This compares of 56.0%.31
with 70.7% in England.30
• This means, however, that local schoolchildren
• Although the proportion of local children being who were eligible for free school meals were
ready for school has increased from 52.0% in less likely to be ‘ready for school’ at the end of
2012/13, current levels remain significantly below Reception compared with other schoolchildren
the England average. (55.9% versus 66.1%).
28.
7. DEVELOPING WELL –
CHILDHOOD INTO YOUNG
ADULTHOOD
29.
DEVELOPING WELL – CHILDHOOD INTO
YOUNG ADULTHOOD
40,027 schoolchildren
7,952 have free school meals
2,523 have a learning disability
58% of Key Stage 2 pupils (10-11 year olds)

meet expected standards (England 65%)
53.3%
of Key Stage 4 pupils (15-16 year olds)
achieved a 9-4 pass including English
and maths (England 59.1%)
19.2%
Healthy
Healthy
of Reception pupils (4-5 year olds)
are overweight or obese (England 22.4%)
37.1%
of Year 6 pupils (10-11 year olds) are
overweight or obese (England 34.3%)
12.8% Teenage pregnancies

(15-17 year olds) have fallen
47%
of 5-19 year olds by
estimated to have a
between 2012 and 2016
Hospital admissions for
self-harm getting worse
(10-24 year olds)
30.
7.1 School characteristics 7.3 Pupil absence
The January 2018 school Census32,33 for Stoke-on- • Overall absence rates among primary and
Trent showed that: secondary school children in Stoke-on-Trent
were slightly higher compared with England in
• There were around 40,000 pupils attending 2016/17 (4.3% versus 4.0% for primary pupils,
schools in the city. and 5.7% versus 5.4% for secondary pupils).35
• Nearly 8,000 pupils attending a school were • Persistent absence rates were higher among local
eligible for and claiming a free school meal primary and secondary pupils compared with
(20.1% compared with 13.5% for England). England (9.7% versus 8.3% for primary pupils,
and 15.6% versus 13.5% for secondary pupils).35
• Just over 12,000 pupils attending a school were
from a ‘Non-White British’ background (30.7% • The rate of fixed period exclusions (6.7%
versus 32.2% for England). versus 4.8%), along with the rate of permanent
exclusions (0.15% versus 0.10%), were both
• Over 8,200 pupils do not have English as their higher in Stoke-on-Trent (in 2016/17) compared
first language (21.0% compared with 19.3% for with England.36
England).
7.4 School attainment
• Almost 1,500 pupils attending schools had a
Statement of Special Educational Needs or an • At Key Stage 2 (10-11 year olds), 58% of pupils
Education, Health and Care Plan (3.6% compared in Stoke-on-Trent met the expected standards in
with 2.9% for England). reading, writing and maths compared with 65% in
England (in 2017/18).37
• A further 5,300 pupils received Special
Educational Need support in Stoke-on-Trent • Locally, the proportion meeting the expected
(13.3% versus 11.7% nationally). standards has improved from 56% in 2016/17
(nationally, it has improved from 62%).
7.2 Learning disabilities
• In 2017/18, 42% of Key Stage 2 pupils in Stoke-
In regards to schoolchildren with learning disabilities ii on-Trent eligible for free school meals met the
known to schools, 2018 data for Stoke-on-Trent expected standards in reading, writing and maths
showed there were:34 compared with 63% of all other pupils (nationally,
46% of pupils eligible for free school meals met
• Over 2,500 pupils with learning disabilities known the expected standards compared with 68% of all
to schools in the city, which is a rate of 63.0 (per other pupils).37
1,000 pupils) compared with 33.9 for England.
• At Key Stage 4 (15-16 year olds), just over half of
• A rate of 58.2 (per 1,000 pupils) with moderate pupils in Stoke-on-Trent (53.3%) achieved a 9-4iii
learning disabilities known to schools in the city pass (including English and Maths) compared
compared with 28.9 in England. with 59.1% in England in 2017/18.38
• A rate of 3.6 (per 1,000 pupils) with severe • Just under one third of local pupils (32.3%)
learning disabilities known to schools across the achieved a strong (9-5) pass (including English
city compared with 3.7 in England. and Maths) compared with 39.9% in England.
• A rate of 1.3 (per 1,000 pupils) with profound and • Stoke-on-Trent had a lower average Attainment
multiple learning disabilities known to schools 8iv score for pupils in secondary school compared
in Stoke-on-Trent (which was the same as with England (in 2017/18) – 41.7 versus 44.3.38
England).
ii
Based on pupils recorded as having moderate, severe or profound and multiple learning difficulties.
iii
A new grading system was introduced in 2017/18 for secondary schools in England. Under the new system, a score of 9-4 is broadly equivalent to
the old *A-C GCSE. A score of 9-4 is considered a ‘standard pass’, whilst a score of 9-5 is considered a ‘strong pass’.
iv
Attainment 8 is a measure of a pupil’s average grade across a set of eight subjects in secondary school.
31.
7.5 Not in education, employment or training • Levels of excess weight in Year 6 locally are
significantly higher than England.
• The proportion of young people aged 16-17 who
were not in education, employment or training Being underweight, just like being overweight or
(NEET) or whose activity is not known was 4.4% obese, can affect a child’s health. Children need the
in Stoke-on-Trent compared with 6.0% in England right vitamins and nutrients to help them grow and
(in 2016).39 This equates to 240 local young develop, and being underweight may be a sign that a
people. child is malnourished.
7.6 Children’s weight • The proportion of Reception schoolchildren
across the city who are underweight has
The health consequences of childhood obesity are increased from 0.8% in 2012/13 to 2.5% in
far reaching and can include: increased blood lipids, 2017/18 (nationally, the proportion has increased
glucose intolerance, type 2 diabetes, hypertension, slightly from 0.9% to 1.0%).42
exacerbation of conditions such as asthma and
psychological problems such as social isolation, low • During this time, the number of Reception
self-esteem, teasing and bullying.. children underweight locally has increased from
26 to 83. Levels of children underweight locally
• The prevalence of schoolchildren in Stoke-on- are significantly higher than England.
Trent who were overweight or obese in Reception
(4-5 year olds) has fallen recently from 26.3% in • The proportion of Year 6 children in Stoke-on-
2015/16 to 19.2% in 2017/18 (figure 10).40 This is Trent underweight has increased from 1.3%
below the national average of 22.4%. in 2013/14 to 1.8% in 2017/18 (nationally, the
proportion has remained around 1.4%).42
• The proportion of schoolchildren with excess
weight in Year 6 (10-11 year olds) has remained • During these years, the number of Year 6 pupils
largely unchanged over the past several years in underweight in the city has increased from 32
Stoke-on-Trent and is currently 37.1% (compared to 54.
with 34.3% in England).41
• The 2017/18 data suggests that nearly 140
• This means that around 1,100 of the 3,000 Year 6 Reception and Year 6 schoolchildren were
pupils in the city were either overweight or obese. underweight in the city.
Figure 10 Schoolchildren overweight or obese in Stoke-on-Trent (2006/07 to 2017/18)

45
40
35
30
25
%
20
15
Stoke - Reception
10
England - Reception
Stoke - Year 6
5
England - Year 6
0
2006/07 2008/09 2010/11 2012/13 2014/15 2016/17
Academic year
32.
7.7 Smoking, alcohol and drug use 7.9 Children’s safeguarding
Local data from the Young People’s Lifestyle Survey • There were 3,200 children in need in Stoke-on-
found that:43 Trent (as at 31 March 2018), and locally this is the
lowest number since 2012/13.44
• The proportion of current smokers among
secondary school pupils in the city has fallen from • The current rate of children in need is higher
13% in 2009 to 5% in 2017. locally compared with England (558.7 (per 10,000
children) versus 341.0).
• The proportion of pupils who had ever tried
smoking fell from 40% in 2009 to 17% in 2017. • There were 280 children who were the subject of
a child protection plan (CPP) in Stoke-on-Trent
• The proportion of young people exposed to (as at 31 March 2018).44 This number has fallen
secondhand smoke in their homes fell from 28% sharply from the 411 in the previous year.
in 2009 to 14% in 2017. The proportion exposed
to secondhand smoke in their bedrooms fell • At the commencement of the CPPs across the city,
during this time from 16% to 3%. 61% were due to neglect, 29% due to emotional
abuse, 6% due to sexual abuse and 4% due to
• In 2017, 7% of pupils were current e-cigarette physical abuse. Nationally, the respective figures
users. for these categories of abuse were: 48%, 35%, 4%
and 8% (5% were due to multiple types of abuse).
• The proportion of pupils who drank alcohol in the
last month has fallen steadily from 48% in 2009 to • The current rate of children subject to a CPP is
27% in 2017. higher in Stoke-on-Trent compared with England
(48.9 (per 10,000 children) versus 43.3).
• Two thirds of Year 11 pupils (15-16 year olds) had
ever tried alcohol in 2017 compared with 84% in • There were 740 looked after children (LAC) in
2009. Stoke-on-Trent (as at 31 March 2018).45 The
number of LAC in the city has increased year on
• The proportion of young people who had taken year since 2009/10 when there were 405 LAC.
any sort of drug in the last month fell from 6% in
2009 to 2% in 2017. • The latest LAC rate (per 10,000 children under
18) was double the national average (129.0
• The proportion of pupils who had ever taken compared with 64.0).
cannabis has fallen from 10% in 2009 to 4% in
2017.
7.10 Wellbeing of pupils
7.8 Referrals to children’s social care
• The proportion of all school pupils in Stoke-on-
• In 2017/18 there were nearly 4,700 referrals Trent with social, emotional and mental health
to children’s social care in Stoke-on-Trent.44 needs was 2.6% compared with 2.4% in England
Referral rates locally have increased from 604.7 in 2018.46 This means there are around 1,000
(per 10,000 children under 18) in 2009/10 to local pupils with social, emotional and mental
815.1 in 2017/18. The current national rate is health needs.
552.5 and has remained largely unchanged since
2009/10. • Among secondary school pupils, the proportion
with social, emotional and mental health needs
• Nearly one quarter (23.3%) of referrals in Stoke- locally was 2.7% (2.3% in England); for primary
on-Trent were repeat referrals (that is, referrals age children, the proportion locally was 2.3%
which were within 12 months of a previous compared with 2.2% nationally.
referral). The proportion of re-referrals locally is
slightly higher than the England average (21.9%).
33.
7.11 Wellbeing of looked after children 7.12 Wellbeing of all children
The mental health of all children is important. With Based on national estimates:49
half of adult mental health problems starting before
the age of 14, early intervention to support children • 9.5% of children aged 5-10 were estimated to
and young people with mental health and emotional have a mental health disorder, which equates to
wellbeing issues is very important. around 1,900 children in the city.
An average ‘difficulties’ score has been used to • 14.4% of children aged 11-16 were estimated to
measure the wellbeing of looked after children (LAC) have a mental health disorder, which equates to
who have been in care continuously for at least 12 around 2,400 children in Stoke-on-Trent.
months. A higher score indicates greater difficulties
(a score under 14 is considered normal, 14-16 is • 16.9% of young people aged 17-19 were
borderline cause for concern and 17 or over is a cause estimated to have a mental health disorder, which
for concern). equates to around 1,500 young people across the
city.
• The average difficulties score for LAC (aged 5-16)
who had been in care continuously (for at least 12 • Overall, 12.8% of 5-19 year olds were estimated
months) was 14.3 in Stoke-on-Trent compared to have a mental health disorder, which equates
with 14.1 for England (in 2016/17).47 This score to around 5,900 children and young people in
has remained unchanged since 2012/13. Stoke-on-Trent.
• Just under half (49.0%) of LAC who had been in

care continuously (for at least 12 months) in the
city had an average difficulties scored which was
considered normal, 9% were borderline cause for
concern, whilst a further 42% were a cause for
concern (similar to national averages).48
34.
7.13 Self-harm
Self-harm is not only an important indicator of mental • Admissions to hospital as a result of self-harm
distress, it also remains one of the most significant among both 15-19 and 20-24 year olds are
risk factors for suicide. Hospital admission data for increasing, with local rates significantly higher
self-harm shows that: than national averages. Among 10-14 year olds,
rates have fallen in recent years and are now
• There were 302 hospital admissions as a result of similar to the national average.46
self-harm among children and young adults aged
10-24 years in Stoke-on-Trent in 2016/17 (figure
11).46
• The number of admissions locally has increased

year on year since 2011/12, and the current
admissions rate of 640.0 (per 100,000) is
significantly higher than the national average of
407.1.
Figure 11 Hospital admissions as a result of self-harm in people aged 10-24 years in Stoke-on-Trent
(2011/12 to 2016/17)
800
700
Directly standardised rate per 100,000 (aged 10 -24)
600
500
400
300
200
Stoke
England
100
0
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Year
35.
7.14 Unintentional and deliberate injuries
Injuries are a leading cause of hospitalisation and • Among 0-14 year olds, there were 459 admissions
represent a major cause of premature mortality for locally in 2016/17.50 The admission rate
children and young people. They are also a cause of continues to fall across the city (figure 13), with
long-term health issues. the current rate of 94.7 (per 10,000) being similar
to the national rate (101.5).
• There were 194 hospital admissions among
children aged 0-4 years for unintentional and • For children and young people aged 15-24,
deliberate injuries in Stoke-on-Trent in 2016/17.50 there were 511 admissions in Stoke-on-Trent
The admission rate locally has fallen in recent in 2016/17.51 Admission rates have remained
years, and the current rate of 108.6 (per 10,000) unchanged locally since 2010/11, and the
is significantly lower than the national average of current rate of 157.9 (per 10,000) in the city is
126.3 (figure 12). significantly higher than the national rate of 129.2
(figure 14).
Figure 12 Hospital admissions caused by unintentional and deliberate injuries in children aged 0-4
years in Stoke-on-Trent (2010/11 to 2016/17)
250
200
Crude rate per 10,000 (aged 0-4 )
150
100
Stoke
England
50
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Year
36.
Figure 13 Hospital admissions caused by unintentional and deliberate injuries in children aged 0-14
180
160
140
120
Crude rate per 10,000 (aged 0 -14)
100
80
Stoke
60
England
40
20
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Year
Figure 14 Hospital admissions caused by unintentional and deliberate injuries in people aged 15-24
200
180
160
140
120
100
80
60
Stoke
40 England
20
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Year
37.
7.15 Hospital admissions for asthma, diabetes
or epilepsy
This measure is concerned with how successfully • In spite of this fall, the current admission rate in
the NHS manages to reduce avoidable emergency the city remains significantly higher than England
hospital admissions for children with asthma, (435.5 (per 100,000) compared with 303.7).
diabetes or epilepsy. These three conditions
are important as they account for around 94% of • The rate of emergency admissions to hospital for
emergency admissions for children (aged under 19) lower respiratory tract infections among those
with long-term conditions. aged under 19 has increased in Stoke-on-Trent
since 2012/13 (figure 16).53 There were 504
• After steadily increasing between 2003/04 and admissions locally in 2016/17.
2013/14, the rate of emergency admissions to
hospital for asthma, diabetes and epilepsy has • The current admission rate of 823.9 (per 100,000)
fallen more recently among those aged under 19 is significantly higher in Stoke-on-Trent than the
in Stoke-on-Trent (figure 15).52 There were 266 England average of 446.4.
admissions locally in 2016/17.
Figure 15 Emergency admissions for asthma, diabetes and epilepsy (under 19 year olds) in Stoke-on-
Trent (2003/04 to 2016/17)
700
Indirectly standardised rate per 100,000 (under 19)
600
500
400
300
Stoke
200
England
100
Data suppressed in 2007/08
due to small numbers
0
2003/04 2005/06 2007/08 2009/10 2011/12 2013/14 2015/16
Year
Source: NHS Digital 2018
Figure 16 Emergency admissions for lower respiratory tract infections (under 19 year olds) in Stoke-
on-Trent (2003/04 to 2016/17)
1,200
Indirectly standardised rate per 100,000 (under 19)
1,000
800
600
400
200 Stoke
England
0
2003/04 2005/06 2007/08 2009/10 2011/12 2013/14 2015/16
Year
38.
7.16 Teenage pregnancy
While for some young women having a child when • In spite of this fall, the current conception rate in
young can be a very positive experience, for many Stoke-on-Trent remains significantly higher than
other teenagers bringing up a child is extremely England.
difficult and often results in poor outcomes (for both
the teenage parent and the child). • The number of conceptions to girls under 16
in Stoke-on-Trent remains low and in 2016 the
Teenage mothers are less likely to finish education, local conception rate was similar to the national
more likely to bring up their child alone and in poverty average – 4.9 versus 3.0 (per 1,000 females aged
and have a higher risk of poor mental health than 13-15).55 There were 19 conceptions in the city in
older mothers. Health and social outcomes for 2016, the lowest number there has been.
children of teenage parents are often poorer.
• The under 18 conception rate in Stoke-on-Trent

has fallen dramatically in recent years and in
2016 was 28.6 (per 1,000 females aged 15-17)
compared with 18.8 in England (figure 17).54
There were 116 conceptions across the city in
2016 compared with 314 a decade earlier.
Figure 17 Under 18 teenage conception rates (females aged 15-17) in Stoke-on-Trent (1998-2016)
90
80
70
Crude rate per 1,000 females (aged 15-17)
60
50
40
30
20
Stoke
England
10
0
1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year
39.
7.17 First time entrants to the Youth Justice
System
Children and young people at risk of offending or • The current 2017 rate of FTEs in Stoke-on-Trent
within the youth justice system often have more is significantly higher than the England average
unmet health needs than other children. (385.6 (per 100,000 10-17 year olds) versus
292.5, figure 18).
• In 2017 there were 86 first time entrants (FTE) to
the Youth Justice System in Stoke-on-Trent – this
compares with 208 in 2010.56
Figure 18 First time entrants to the Youth Justice System (10-17 year olds) in Stoke-on-Trent
(2010-2017)
1,200
1,000
800
600
Stoke
400
England
200
0
2010 2011 2012 2013 2014 2015 2016 2017
Year
7.17 Reoffending 7.18 Road traffic accidents
• The proportion of juvenile offenders (aged 10-17) • The number of children under 16 killed and
who reoffend in Stoke-on-Trent has remained seriously injured on roads in Stoke-on-Trent
unchanged between 2006 and 2016 with 41.3% remain low, with just 20 casualties between 2014
of offenders reoffending in 2006 compared with and 2016.58 The local rate of 13.2 (per 100,000
41.7% in 2016.57 under 16) is lower than the England rate of 17.1.
• Nationally, levels of reoffending have increased

from 38.4% in 2006 to 41.6% in 2016.
40.
8. LIVING WELL –
WORKING AGE ADULTS
41.
LIVING WELL – WORKING AGE ADULTS
Around
2,500 deaths 24,674

Top 3 killers
a year
adults
(18-64) have a common
28.7% 23% 16.1%

3,758 adults
Cancer Circulatory Respiratory (18-64) with a learning disability
Disease Disease
9 smokers die
20.7% of adults (18+)
smoke each week
Healthy
Healthy
66.0%
of adults (18+) are
overweight or obese
45.2%
of adults (16+) do
54.1%
(19+)
30.9%
(19+)
not eat enough

fruit and veg Do enough Don’t do any
exercise exercise
42.
44.0%
of adults (18+)
are drinking at
dangerous levels
21.9%
of alcohol users
Deaths and hospital
admissions from alcohol
are higher than England:
successfully 3 drinkers die each week
complete treatment
(England 38.9%)
12.3%
of adults (16-64) have no
More people use qualifications (England 7.6%)
drugs in the city
23.4%
of adults are qualified to NVQ
level 4 and above (England 38.3%)
Around
30,000 recorded
crimes
– an increase of
9,500 since
2012/13
43.
8.1 Burden of disease 8.2 Major killers
Stoke-on-Trent is the 14th most deprived local • Around 2,500 people die each year in Stoke-on-
authority (out of 326) in England (based on the Trent.60
2015 Index of Multiple Deprivation).11 Deprivation,
along with the wider determinants of health such as • The three leading causes of deaths in the city (in
individual lifestyles, housing and working conditions, 2015-2017) were: cancer (28.7% of all deaths),
have a big impact on people’s health. circulatory disease (23.0%), and respiratory
disease (16.1%). These three conditions were
Latest data from the Global Burden of Disease59 responsible for over two thirds of all deaths
project shows that, when compared with the other (67.8%), which is similar to England (66.9%).60
150 upper tier local authorities in England, Stoke-on-
Trent has: 8.3 Preventable mortality
• The second highest rate of premature mortality Preventable mortality looks at deaths which could be
(under 75) – Blackpool is highest. avoided by public health interventions in the broadest
sense. The major causes of preventable deaths are
• Is the worst area in England for the number of the wider determinants of health, such as individual
years of lost life to congenital birth defects and lifestyles, education, housing, employment, along
the third worst for neonatal preterm births. with the wider economic conditions.
• It is the third worst area for loss of years to • In Stoke-on-Trent, there were over 1,700 deaths
pancreatic cancer and among the top 10 worst (in 2015-17) that were considered preventable.61
areas for chronic obstructive pulmonary disease. This means that nearly one quarter of local deaths
(22.8%) could have been prevented, which is
• People in Stoke-on-Trent also lose a significantly higher than the England average (18.9%).
higher number of years of life to coronary heart
disease and lung cancer compared with the • Rates of premature mortality have remained
England average. unchanged in Stoke-on-Trent since 2010-12,
whilst they have continued to fall in England
(figure 19). Locally, the 2015-17 rate
Figure 19 First time entrants to the Youth Justice System (10-17 year olds) in Stoke-on-Trent
(2010-2017)
400
350
Directly standardised rate per 100,000 (all ages)
300
250
200
Stoke
150
England
100
50
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
44.
8.4 Premature mortality (under 75)
• During 2015-17, around 2,800 people died • Mortality rates from circulatory disease have
prematurely under the age of 75 in Stoke-on- reduced more quickly locally (53%) compared
Trent.62 with cancer (17%) and respiratory disease
(11%).
• The premature mortality rate from all causes has
fallen slightly in the city from 467.0 (per 100,000) • Cancer is responsible for the largest proportion of
in 2011-13 to 435.1 in 2015-17 (figure 20). premature deaths in the city (37.8%; circulatory
disease = 20.5%, respiratory disease = 11.3%).
• In spite of this fall, the current all cause mortality
rate in the city is significantly higher than the • In spite of the falls, mortality rates from the three
England average of 331.9. leading causes remain significantly higher in the
city compared with England.
• Premature mortality rates from the three leading
causes of death – cancer,63 circulatory disease64 • Premature mortality rates from liver disease
and respiratory disease65 – continue to fall in continue to increase locally, with the local rate
Stoke-on-Trent (figures 21-23). being significantly higher than England (figure
24).66
Figure 20 Mortality from all causes (aged under 75) in Stoke-on-Trent (2011-13 to 2015-17)
600
500
Directly standardised rate per 100,000 (under 75)
400
300
Stoke
200
England
100
0
2011-13 2012-14 2013-15 2014-16 2015-17
Year
45.
Figure 21 Mortality from cancer (aged under 75) in Stoke-on-Trent (2001-03 to 2015-17)
250
200
150
100
Stoke
England
50
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
Figure 22 Mortality from circulatory disease (aged under 75) in Stoke-on-Trent (2001-03 to 2015-17)
250
200
150
100
50
Stoke
England
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
46.
Figure 23 Mortality from respiratory disease (aged under 75) in Stoke-on-Trent (2001-03 to 2015-17)
70
60
50
40
30
20
Stoke
England
10
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
Figure 24 Mortality from liver disease (aged under 75) in Stoke-on-Trent (2001-03 to 2015-17)
40
35
Directly standarised rate per 100,000 (under 75)
30
25
20
15
10
Stoke
England
5
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
47.
8.5 Wellbeing
People with higher levels of wellbeing have lower • 5.3% of adults were not satisfied with their lives
rates of illness, recover more quickly and for longer, (4.4% in England)
and generally have better physical and mental health. • 4.1% felt the things they did in their lives were not
Four outcomes of wellbeing are routinely measured: worthwhile (3.6% nationally)
satisfaction, things that are worthwhile, happiness • 10.1% of people did not feel happy (8.2% in
and anxiety. In Stoke-on-Trent in 2017/18:67 England)
• 20.1% felt anxious (20.0% nationally, figure 26)
• 78.0% of people (aged 16 and over) were
satisfied with their lives (82.0% in England) • Since 2011/12, levels of wellbeing in Stoke-on-
• 79.8% felt the things they did in their lives were Trent have improved across all four outcomes.
worthwhile (84.2% nationally)
• 70.4% of people felt happy (compared with 75.3%
in England)
• 62.9% did not feel anxious (63.4% nationally,
figure 25)
Figure 25 Wellbeing outcomes (aged 16 and over) in Stoke-on-Trent (2017/18)

90
Stoke
80
England
70
60
50
40
%
30
20
10
0
High satisfaction High worthwhile High happiness Low anxiety
Wellbeing outcome
Figure 26 Wellbeing outcomes (aged 16 and over) in Stoke-on-Trent (2017/18)

25
20
Stoke
15
England
%
10
0
Low satisfaction Low worthwhile Low happiness High anxiety
Wellbeing outcome
48.
8.6 Mental health conditions
• There were nearly 32,000 patients (aged 18 • Across all four conditions, around 39,900
and over) with depression that were registered patients across the city were on GP registers
with general practices in the area covered by (notwithstanding that some patients may have
Stoke-on-Trent Clinical Commissioning Group in more than one condition, whist others may not be
2017/18 (figure 27).68 This is 14.0% of all patients recorded as having a mental health condition).
compared with 9.9% across England.
• The number of adults (aged 18-64) in Stoke-
• The prevalence of dementia, epilepsy and other on-Trent with a common mental health disorder
severe mental health conditions were higher (such as anxiety and depression) is currently
locally compared with England. around 24,700 (in 2017). By 2030, this number is
predicted to fall slightly to around 24,300.69
Figure 27 Prevalence of patients on GP registers with mental health conditions in Stoke-on-Trent

(2017/18)
16
14
12
10
Stoke
% 8 England
0
Dementia (all ages) Epilepsy (18+) Depression (18+) Severe mental illness (all
Mental health outcome ages)
49.
8.7 Suicides
Suicide is a significant cause of death in young adults, • The current rate in the city of 9.1 remains below
and is seen as an indicator of underlying rates of the national average of 9.6.
mental ill-health.
• The suicide rate has fallen in Stoke-on-Trent from

a high of 14.1 in 2011-13 to 9.1 (per 100,000, 10
years and over) in 2015-17 (figure 28).70
Figure 28 Mortality from suicides (aged 10 years and over) in Stoke-on-Trent (2001-03 to 2015-17)
20
18
16
Directly standardised rate per 100,000 (10 years and over)
14
12
10
Stoke
4
England
0
2001-03 2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
Year
50.
8.8 Intentional self-harm
Self-harm results in over 100,000 admissions to • The emergency hospital admission rate for
hospital a year in England, and 99% of these are intentional self-harm has increased recently in
emergency admissions. Self-harm is an indication Stoke-on-Trent and was 348.4 (per 100,000, all
of personal distress, and there is a significant and ages) in 2016/17 compared with 185.3 in England
persistent risk of future suicide following an episode (figure 29).71 This is significantly higher than the
of self-harm. England rate.
The following indicator is being used as a proxy • This means locally there were 889 emergency
measure of the prevalence of severe self-harm, admissions in 2016/17 compared with 596 in
and as such, is likely to be only the tip of the iceberg 2010/11, an increase of nearly 300 over the past
in regards to the health and wellbeing burden and six years.
impact of self-harm.
Figure 29 Emergency hospital admissions (all ages) for intentional self-harm in Stoke-on-Trent
(2010/11 to 2016/17)
450
400
350
Directly standardised rate per 100,000 (all ages)
300
250
200
150
100
Stoke
England
50
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Source: Public Health England 2018 Year
8.9 Learning disabilities
• There were an estimated 3,800 adults (aged 18- disability (and hence likely to be receiving
64) with a learning disability in Stoke-on-Trent services) in Stoke-on-Trent in 2017. This number
(in 2017). This number is predicted to remain is predicted to remain unchanged by 2030.69
unchanged by 2030.69
• Around 1,600 adults (aged 18-64) were estimated
• There were around 860 adults (aged 18-64) to have autistic spectrum disorders locally
estimated to have a moderate or severe learning in 2017. This number is predicted to remain
unchanged by 2030.69
51.
8.10 Smoking
Smoking is the most important cause of preventable Smoking accounts for around 1 in 6 of all deaths in
ill-health and premature mortality in the UK. England, and there exist huge inequalities in smoking
Smoking is a major risk factor for many diseases, related deaths: areas with the highest death rates
such as lung cancer, chronic obstructive pulmonary from smoking are about three times as high than
disease and heart disease. It is associated with a areas with the lowest death rates attributable to
range of other cancers such as lip, mouth, throat, smoking.
bladder, kidney, stomach, liver and cervix.
• In 2015-17, there were 1,474 smoking
• Local data from the 2018 Adult Health and attributable deaths in Stoke-on-Trent.73
Lifestyle Survey72 shows that the prevalence of
smoking in Stoke-on-Trent (among adults aged • The current mortality rate from smoking has
18 and over) has fallen from 28.0% in 2012 to fallen locally from 435.9 (per 100,000, 35 and
20.7% in 2018 (figure 30). over) in 2007-09 to 382.4 in 2015-17. In spite of
this fall, the current mortality rate in Stoke-on-
• This means that around 49,500 adults (aged 18 Trent remains significantly above the England
and over) are likely to be current smokers across average of 262.6
the city.
Other findings from the survey show that:72

• 20% of men smoked compared with 22% of
women
• young adults aged 18-24 were most likely to
smoke (28%)
• 27% of people living in the most deprived area
of the city smoked
• 6% of people living in the least deprived areas
smoked
• ‘White’ people (21%) were more likely to
smoke compared with Asians (11%)
Figure 30 Prevalence of smoking (aged 18 and over) in Stoke-on-Trent (2012-2018)

30
25
20
15
%
10
Stoke
England
5
2014 and 2015 figures

estimated for Stoke-on-Trent
0
2012 2013 2014 2015 2016 2017 2018
Year
Source: Public Health England 2018, Stoke-on-Trent City Council 2018
52.
8.11 Excess weight 8.12 Healthy eating
Being obese can increase a person’s risk of Poor diet (and obesity) are leading causes of
developing many potentially serious health premature death and mortality, and are associated
conditions, including: type 2 diabetes, high blood with a wide range of diseases including circulatory
pressure, high cholesterol, coronary heart disease disease and some cancers. The costs of diet related
and stroke, liver disease and kidney disease, along chronic diseases to the NHS are considerable.
with several types of cancer, including breast and Average intakes of saturated fat, sugar, and salt are
bowel cancer. Obesity can reduce life expectancy by above recommended levels, while intakes of oily fish,
an average of 3 to 10 years, depending on how severe fibre and some vitamins and minerals remain below
it is. recommendations.
Obesity can also affect people’s quality of life and • In 2018, 55.6% of food outlets in Stoke-on-Trent
lead to a range of psychological problems, such as were classified as fast food outlets (compared
depression and low self-esteem. Other day-to-day with 38.4% in the UK).75 Between 2010 and 2018,
problems related to obesity include: breathlessness, the average number of fast food outlets across
difficulty doing physical activity, feelings of tiredness, the city increased from 48.5 (per 100,000) to 69.5.
joint and back pain, low confidence and feeling Locally, an extra 55 takeaways opened in Stoke-
isolated. on-Trent between 2010 and 2018.
• Data from the Active Lives Survey found that just • Data from the Active Lives Survey found that
under two thirds (66.0%) of adults aged 18 and just over half (54.8%) of adults aged 16 and over
over in Stoke-on-Trent were either overweight or reported that they had eaten the recommended
obese in 2016/17.74 This compares with 61.3% in five portions of fruit and vegetables (on a usual
England. day) in Stoke-on-Trent in 2016/17.76 This was
similar to the England average of 57.4%.
• This means locally that around 131,000 adults
(aged 18 and over) are likely to have a weight • This means locally that around 92,000
problem in the city. adults (aged 16 and over) are not eating
the recommended five portions of fruit and
vegetables on a daily basis in the city.
53.
8.13 Physical activity
Physical inactivity is the fourth leading risk factor • This means that, across the city, an estimated
for global mortality, accounting for 6% of deaths 60,300 adults are physically inactive.
globally. People who have a physically active
lifestyle have a 20-35% lower risk of circulatory • Locally, 12.6% of adults (aged 16 and over)
disease compared with those who have a sedentary used outdoor green space for exercise or health
lifestyle. Regular physical activity is also associated reasons, which is significantly below the England
with a reduced risk of diabetes, obesity, osteoporosis, average of 17.9% (March 2015 to February
colon and breast cancer and with improved mental 2016).79
health.
In regards to the quantity of green space available
The Chief Medical Officer (CMO) recommends that in the city, information from the city council’s 2018
adults should undertake a minimum of 150 minutes Green Space Strategy found that:80
(2.5 hours) of moderate physical activity per week.
• Adults believe there is ‘not enough’ provision of
• Just over half (54.1%) of adults aged 19 and over recreation amenities across the city, whereas
in Stoke-on-Trent met the recommended levels of young people tend to think provision is ‘about
physical activity in 2016/17, which is significantly right’ or ‘more than enough’.
below the national average of 66.0% (figure 31).77
• People believe that there is ‘not enough’ or ‘about
• This means that an estimated 89,500 adults right’ provision of parks and gardens in the city.
in Stoke-on-Trent are not meeting the
recommended levels of physical activity as set • People believe there is ‘not enough’ provision of
out by the CMO. playgrounds across the city.
• In 2016/17, 30.9% of adults (aged 19 and over) in • People believe there is ‘not enough’ or ‘about
Stoke-on-Trent were classed as being physically right’ provision of green corridors, rivers or
inactive (doing less than 30 minutes of moderate canals in the city.
intensity activity per week).78 This was higher
than the England average of 22.2%. • People believe that there is ‘not enough’ or ‘about
right’ provision of allotments in the city.
Figure 31 Physical activity levels (aged 19 and over) in Stoke-on-Trent (2016/17)

70
60
50
40
30
20
10
0
Stoke - active England - active Stoke - inactive England - inactive
Level of physical activity
54.
8.14 Alcohol 8.15 Drugs
Alcohol is a causal factor in more than 60 medical An estimated 300,000 people in England are
conditions, including circulatory and digestive dependent on heroin and/or crack cocaine.
diseases, liver disease, a number of cancers and Increasing numbers of people are reportedly
depression. Alcohol is the leading risk factor for ill- having problems with other drugs such as cannabis,
health, early mortality and disability among people new psychoactive substances and image and
aged 15-49 years in the UK. Alcohol-related harm performance-enhancing drugs. Concern is also
falls disproportionately on poorer families. growing about the misuse of, and dependence on,
prescribed and over-the-counter medicines.
Binge drinking can lead to injuries, anti-social
behaviour and other harm to communities. Alcohol A person’s drug use or dependence can significantly
misuse also causes losses to business and the local affect their families, friends, communities, along with
economy through absenteeism, poor performance their own health. Data for Stoke-on-Trent shows
and workplace accidents. Alcohol also causes harm there were:
to others. It is associated with family and relationship
problems, and is a significant contributory factor in • An estimated 2,654 opiate and crack users aged
offences of violence and disorder including domestic 15-64 (2014/15).85
violence.
• A higher rate of opiate and crack use in the city
• In 2017, there were over 2,200 years of life lost (16.4) compared with England (8.6 (per 1,000,
due to alcohol-related conditions in Stoke-on- 15-64 year olds), 2014/15).85
Trent.81
• A higher proportion of local people (27.4%) in
• On average, nearly three people (2.8) die a week drug treatment (aged 18 and over) who were in
in the city from an alcohol-related problem.82 contact with the criminal justice system compared
with England (20.9%, 2017/18).86
Latest data from the Local Alcohol Profiles for
England show that (when compared with England), • A lower proportion of local opiate users (aged 18
and over) successfully completing drug treatment
Stoke-on-Trent had significantly higher levels of:83 compared with England (2.0% versus 6.5%,
• alcohol-related mortality (all ages, 2017) 2017). This proportion has fallen locally year on
• alcohol-specific mortality (all ages, 2015-17) year from a high of 7.1% in 2012.87
• mortality from chronic liver disease (all ages,
2015-17) • A lower proportion of local non-opiate users
• hospital admissions for alcohol-specific (aged 18 and over) successfully completing drug
conditions (all ages, 2016/17) treatment compared with England in 2017 (19.2%
• hospital admissions for alcohol-related versus 36.9%). This proportion has fallen locally
conditions (all ages, 2016/17) from a high of 48.4% in 2014.88
• admissions for alcohol-related conditions
(ages 40-64, 65 and over, 2016/17) • 57 deaths (all ages) from drug misuse in the
city in 2015-17 (a local rate of 8.1 (per 100,000)
• Admissions to hospital due to alcohol for a range compared with 4.3 in England).89
of conditions such as circulatory disease, mental
and behavioural disorders, and intentional self-
poisoning are all significantly higher locally.
• Around 1 in 5 alcohol users (21.9%) in Stoke-

on-Trent successfully completed treatment for
alcohol in 2017, which is significantly below
the national average of 38.9%.84 This has fallen
locally from a high of 47.8% in 2014.
• Local estimates from the 2018 Adult Health and

Lifestyle Survey found that around 44% of adults
(aged 18 and over) were drinking at levels of
increasing or higher risk in Stoke-on-Trent.72 This
equates to around 87,200 people across the city.
55.
8.16 NHS Health Checks A high take up of NHS Health Checks is important
to identify early signs of poor health leading to
The NHS Health Checks programme aims to help opportunities for early interventions.
prevent heart disease, stroke, diabetes and kidney
disease through the identification of those at risk or • By the beginning of 2018/19, 45.7% of eligible
undiagnosed. Everyone aged 40-74 (who has not people (aged 40-74) had received an NHS Health
already been diagnosed with one of these conditions) Check in Stoke-on-Trent compared with 37.0% in
should be invited to have a check to assess their risk England (figure 32).90
and given support and advice to help them reduce or
manage that risk. • This means that nearly 32,000 eligible local
people have received a Health Check.
Figure 32 People receiving an NHS Health Check (40-74 year olds) in Stoke-on-Trent (2014/15 to
2018/19, rolling quarters)
50
45
40
Stoke
35
England
30
25
%
20
15
10
Source: Public Health England 2018 Quarter
56.
8.17 Qualifications and skills 8.18 Crime and violence
• The Stoke-on-Trent skills profile shows that Headline findings from the 2017/18 Crime Survey for
12.3% (of 16-64 year olds) have no formal England and Wales show that in Stoke-on-Trent there
qualifications compared with 7.6% in England (in were:93
2017).91
• over 8,200 recorded offences for violence
• Just under one quarter of local people (23.4%) • nearly 4,200 offences of criminal damage and
were qualified to NVQ level 4 and above compared arson
with 38.3% in England.91 • just under 2,800 offences of shoplifting
• over 1,850 offences of burglary
• Around 7% of employers in Stoke-on-Trent said • around 1,200 sexual offences
they had vacancies due to a skills shortage in the • just over 600 drug offences
available labour market (in 2015), which is similar • a total of 29,958 recorded offences across the city
to the national average of 6%.92
• Since 2012/13, the number of recorded offences
• Around 23% of local employers said they had staff in the city has increased by over 9,500 – a rise of
who were not fully proficient due to skills gaps 46.5% compared with a rise of 35.3% in England
(in 2015) compared with the England average of and Wales.
14%.92
Other national data shows that:
• Rates of violent crime (including sexual offences)

continue to increase in Stoke-on-Trent, and the
2017/18 local rate of 42.7 (per 1,000, all ages) is
significantly higher than the England average of
23.7 (this increase could in part be explained by
greater reporting and recording of incidents).94
• Rates of domestic abuse-related incidents

and crime were higher in Stoke-on-Trent than
England in 2016/17 (28.5 versus 22.5 (per
1,000, 16 and over)).95 This is likely to be an
underestimate as the incidents of domestic abuse
tend to be under-reported.
• The proportion of adult offenders (aged 18

and over) who reoffend in Stoke-on-Trent has
remained unchanged between 2006 and 2016
with 31.5% of offenders reoffending in 2006
compared with 32.8% in 2016.57
• Levels of reoffending have remained unchanged

nationally and are currently 28.6%.
57.
8.19 Road traffic accidents
Motor vehicle traffic accidents are a major cause • Nearly 180 people were killed and seriously
of preventable deaths and morbidity (particularly injured on roads in Stoke-on-Trent in 2014-16.96
among younger ages). For children and for men This is the highest number since 2009-11.
aged 20-64 years, mortality rates for motor vehicle
traffic accidents are higher in lower socioeconomic • Although the rate locally is the highest it has
groups. The vast majority of road traffic accidents are been over the last five years (23.4 per 100,000,
preventable and can be avoided through improved all ages), it remains significantly lower than the
education, awareness, road infrastructure and national rate of 39.7 (figure 33).
vehicle safety.
Figure 33 Killed and seriously injured casualties on roads (all ages) in Stoke-on-Trent (2009-11 to
2014-16)
45
40
35
30
Crude rate per 100,000 (all ages)
25
20
15
10
Stoke
England
5
0
2009-11 2010-12 2011-13 2012-14 2013-15 2014-16
Year
58.
9. AGEING WELL –
HEALTHY OLDER PEOPLE
59.
AGEING WELL – HEALTHY OLDER PEOPLE
9,300
An extra
people aged 65 and
over by 2030
Increasing numbers of: limiting long-term illness,
dementia, depression, falls
7 out of 10
people (65+)
3,595
had a flu jab
requests for
support from new clients
956 (aged 65+) to Adult Social Care
emergency hospital admissions

due to falls
– an average of
10 a day
260 emergency admissions

for hip fractures
6 out of 10 people cared for by
38% of people local carers are aged 65 and over

died at home
(England 46.6%)
66.8%
of service users were
39,000
satisfied with the care and
support they received from
social services (England 65.0%)
2.7%
people estimated
of service users did not
to be in fuel poverty feel safe (England 1.8%)
60.
9.1 Future needs
By 2030, the numbers of people aged 65 and over • The numbers of people with depression are
living in Stoke-on-Trent are projected to increase predicted to increase from 3,704 in 2017 to 4,580
by around 9,300, to 52,400.5 This means that nearly in 2030, a rise of 23.7%. The proportion with
1 in 5 local people (19.9%) will be aged 65 and over severe depression is predicted to rise by 27.4%
(compared with 16.9% currently). (from 1,158 to 1,475).
This progressively older population for Stoke- • The numbers of falls among people aged 65 and
on-Trent will mean the numbers of people with over are predicted to increase from 11,292 in 2017
increasingly complex and long-term conditions to 14,379 in 2030, a rise of 27.3%. This could see
(such as hypertension, diabetes, chronic obstructive a further rise of around one third in admissions
pulmonary disease, dementia) will continue to grow, to hospital due to falls (an increase from 865
which in turn will impact on the need and provision admissions to 1,158 by 2030).
for social care support. Among people aged 65 and
over in the city, it is predicted that:97 • The number unable to manage at least one
self-care activity on their own (such as bathing,
• Those with a limiting long-term illness (whose getting dressed, feeding) is predicted to increase
day-to-day activities are limited a lot) are from 13,999 in 2017 to 18,068 by 2030, a rise of
predicted to increase from 14,429 to 18,400 29.1%.
between 2017 and 2030, a rise of 27.5%.
• The number unable to manage at least one
• The proportion of people with dementia is domestic task on their own (such as washing
predicted to rise by over one third by 2030 (with and drying dishes, household shopping, using a
the number increasing from 2,823 to 3,877). vacuum) is predicted to increase from 17,074 to
22,084 between 2017 and 2030, a rise of 29.3%.
• The number of people living with a longstanding
health condition caused by a stroke is predicted to • The proportion of people unable to manage at
increase from 992 in 2017 to 1,265 by 2030, a rise least one mobility activity on their own (such as
of 27.5%. getting up and down the stairs, going out of doors
and walking down the street) is predicted to rise
• Those with a longstanding health condition by 30.7% (increasing from 7,615 in 2017 to 9,949
caused by a heart attack are predicted to rise by by 2030).
25.5% during this period (from 2,105 to 2,642).
• The numbers of people aged 65 and over
providing unpaid care is predicted to increase
locally from 6,515 in 2017 to 7,905 by 2030 (a rise
of 21.3%).
61.
9.2 Long-term conditions
Long-term conditions (LTCs) or chronic diseases Data from patients registered with general practices
are conditions for which there is currently no cure, in the area covered by Stoke-on-Trent Clinical
and which are managed with drugs and other Commissioning Group in 2017/18 show that
treatment. Examples of LTCs include diabetes, (table 1):68
chronic obstructive pulmonary disease, arthritis and
hypertension. • around 48,000 patients (all ages) were recorded
as having hypertension
The numbers of people suffering from LTCs have • nearly 32,000 patients (aged 18 and over) were
risen dramatically in recent years, largely as a result suffering from depression
of the ageing population and lifestyle factors such as • almost 19,000 patients (aged 17 and over) had
smoking, drinking and overeating. diabetes
• 8 of the 10 LTCs were higher in Stoke-on-Trent
LTCs are more common among older people (58% compared with England
of people over 60 suffer from an LTC compared with
14% of people under 40).98 Research has found that • Based on the GP Patient Survey for 2016/17,
nearly two thirds of people aged 65-84 have two or 64.1% of people surveyed in Stoke-on-Trent
more LTCs, whilst among people aged 85 and over, felt supported to manage their long-term
this proportion rises to over 80%.99 condition, which is similar to the national average
(64.0%).100
Table 1 Prevalence of long-term conditions in Stoke-on-Trent (2017/18)
Stoke-on-Trent England
Condition % Number % Number

Hypertension* 16.4 47,820 13.9 8,141,488
Depression (18+) 14.0 31,781 9.9 4,589,213
Diabetes (17+) 8.1 18,708 6.8 3,196,124
Asthma 6.3 18,251 5.9 3,463,893
Chronic kidney disease (18+) 4.1 9,245 4.1 1,907,774
Coronary heart disease 3.6 10,362 3.1 1,827,352
Cancer 2.6 7,556 2.7 1,593,302
COPD** 2.6 7,547 1.9 1,113,417
Stroke & TIA*** 2.1 6,057 1.8 1,030,869
Dementia 0.9 2,712 0.8 446,548
* All ages (unless specified otherwise)
** COPD = chronic obstructive pulmonary disease
*** TIA = transient ischaemic attack (mini-stroke)
62.
9.3 Social care outcomes
• There were 3,595 requests for adult social care The Adult Social Care Survey is an annual survey for
support from new clients aged 65 and over in England which looks at the views of service users
Stoke-on-Trent in 2017/18.101 This is equivalent (aged 18 and over) in receipt of long-term support
to almost 10 requests for support received every services funded or managed by social services. It
day by the city council. is designed to help the adult social care sector
understand more about how services are affecting
• Nearly one quarter of new requests (22.3%) for lives to enable choice and for informing service
older people came from those discharged from development.
hospital.101
Results from the latest 2017/18 survey show that:103
• There were 3,345 adults aged 65 and over who
accessed long-term funded social care support • Two thirds of service users (66.8%) in Stoke-on-
during 2017/18.101 Of these, 2,015 (60.2%) Trent reported they were satisfied with the care
received a community service (including those and support they received (compared with 65.0%
receiving a direct payment or a managed personal in England); 2.7% of local users reported they
budget), 790 (23.6%) were in residential care were dissatisfied (versus 2.0% nationally).
whilst 540 (16.1%) were in a nursing home.
• 61.6% of local users said that their quality of
• Locally, a higher proportion of adults who life was good which was similar to the England
accessed long-term social care support were in average of 62.6%.
nursing homes compared with England (16.1%
versus 13.6%), a lower proportion were in • 28.8% of users felt they did not have enough
residential care (23.6% versus 25.6%), whilst choice over the care and support services they
the proportions who received a community received (compared with 25.8% in England).
service were similar (60.2% locally versus 60.8%
nationally). • 3 in 10 service users (29.5%) said they had as
much control over their daily lives as they wanted
The latest findings from the 2017/18 Adult Social compared with 33.5% in England.
Care Outcomes Framework show that:102
• Just over 70% of users felt as safe as they wanted
• The long-term support needs of older adults to (69.9% in England); 2.7% did not feel safe at all
(aged 65 and over) met by residential and nursing (compared with 1.8% in England).
care homes was lower locally compared with
England (414.3 versus 585.6 per 100,000, 65 and • Under half of local service users (46.7%) said
over). they had enough social contact with the people
they liked (46.0% in England).
• There was a lower proportion of older people
(aged 65 and over) at home 91 days after leaving • 33.8% of users were able to spend time on the
hospital into reablement or rehabilitation services things they valued or enjoyed (compared with
(79.0% versus 82.9% in England). 37.3% in England).
• There was a lower proportion of older people The Survey of Adult Carers in England is a national
(aged 65 and over) in the city receiving survey which takes place every other year. The
reablement or rehabilitation services following survey covers informal, unpaid carers aged 18 and
discharge from hospital (0.8% versus 2.9% in over, caring for a person (aged 18 and over). Results
England). from the latest 2016/17 survey show that:104
• There was a higher rate of delayed transfers of • 70.1% of carers in Stoke-on-Trent who received
care from hospital (25.7 versus 12.3 per 100,000, support or services were satisfied whilst 14.3%
18 and over). were dissatisfied (England 71.0% and 13.3%).
• A higher rate of delayed transfers of care from • 17.2% of local carers said they don’t do anything
hospital (25.7 versus 12.3 per 100,000, 18 and they value or enjoy with their time (15.0% in
over). England).
63.
• 14.5% of carers felt they had no control over their 9.4 Loneliness
daily lives (13.9% in England).
Loneliness can be felt by people of all ages, but as
• 14.7% of carers felt they were neglecting people get older, the risk factors that can lead to
themselves (15.8% in England). loneliness (such as poor health, loss of sight, loss of
mobility, retirement, becoming a carer) increase.
• Nearly 1 in 5 local carers (18.2%) said they
had some worries about their personal safety Loneliness is harmful to our health: lonely people are
(compared with 15.9% in England). more likely to suffer from dementia, heart disease
and depression, whilst loneliness increases the
• 16.6% of carers felt socially isolated locally likelihood of dying by around 25%.105 The effect of
(16.2% in England), whilst a further 45.3% felt loneliness on mortality is comparable to the impact
that, although they had contact with people, it of well-known risk factors such as obesity, and has a
was not enough (48.3% in England). similar influence as cigarette smoking.105
• Over one fifth (22.0%) of carers felt they had The national Community Life Survey is a household
no encouragement or support in their role online/paper self-completion study of adults aged
(compared with 19.5% in England). 16 and over in England. The survey asks about a
range of issues such as social cohesion, community
• 57.0% of local carers who looked for information engagement, along with issues around loneliness.
and advice about support or services in the last
12 months found it easy whilst 43.0% found it Based on findings from the 2017/18 survey:106
difficult (64.2% and 35.8% in England).
• 2.8% of adults in England aged 65 and over said
• Nearly 90% of carers (88.8%) found the they felt lonely ‘often/always’, which equates to
information and advice they received helpful around 1,200 people over 65 in Stoke-on-Trent.
(87.1% in England).
• 12.5% of adults in England over aged 65 felt
• 71.9% of local carers felt they were involved or lonely ‘some of the time’, which equates to around
consulted about the support or services provided 5,400 people over 65 in the city.
to the person they cared for (compared with
70.6% in England). • This means around 6,600 people aged 65 and over
across the city could be experiencing loneliness
• 6 out of 10 people cared for by carers were aged (often/always or some of the time).
65 and over (67.3% in England).
• Over one third of carers (36.0%) had a 9.5 Fuel poverty

longstanding illness themselves (28.6% in
England), 22.4% had sight or hearing loss (16.7% • Around 17,200 households in Stoke-on-Trent
in England) whilst a further 20.5% had a physical were estimated to be experiencing fuel poverty
impairment or disability (20.6% in England). in 2016, which is 15.4% of all local households
(compared with 11.1% in England).107
• This means that around 39,000 local people could

be experiencing fuel poverty in the city.
• Fuel poverty levels in the city were ranked 9th

highest in the country in 2016.
64.
9.6 Pneumococcal and flu vaccinations
Pneumococcal disease is a significant cause of • This is below the current national level of 69.5%.
morbidity and mortality, particularly among people
aged 65 and over. Pneumococcal infections can be • 72.3% of eligible adults aged 65 and over were
non-invasive such as bronchitis or invasive such as vaccinated against flu in Stoke-on-Trent in
septicaemia, pneumonia and meningitis. Cases of 2017/18 (figure 35).109
invasive pneumococcal infection usually peak in the
winter during December and January. • This means that around 35,000 older adults
across the city were vaccinated.
• Nearly 26,000 eligible adults aged 65 and over
received the pneumococcal (PPV) vaccination in • Local vaccination levels are similar to the national
Stoke-on-Trent during 2017/18.108 average (72.3% versus 72.6%).
• Since 2010/11, the proportions of vaccinations

locally have fallen from 69.0% to 64.9% in
2017/18 (figure 34).
Figure 34 PPV vaccinations (aged 65 and over) in Stoke-on-Trent (2010/11 to 2017/18)
80
75
70
65
%
Stoke
60
England
55
50
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Year
Figure 34 Flu vaccinations (aged 65 and over) in Stoke-on-Trent (2010/11 to 2017/18)

85
80
75
70
%
65
Stoke
60
England
55
50
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Year
65.
9.7 Excess winter deaths
The number of excess winter deaths depends on • In 2016/17 there were 190 excess winter deaths
the temperature, the ability of people to adequately (all ages) in Stoke-on-Trent, the highest number
heat their homes (fuel poverty), levels of disease locally since 2008/09 (when there were 240).110
as well as other factors, such as how well people
can cope with the drop in temperature. Most excess • The excess winter deaths index (percentage) has
winter deaths are due to circulatory and respiratory fluctuated over time, with the current percentage
diseases, and the majority occur amongst the elderly. being higher in the city compared with England
(23.9% versus 21.2%, figure 36).
Figure 36 Excess winter deaths (all ages) in Stoke-on-Trent (2001/02 to 2016/17)

45
40
35
Stoke
England
30
Excess winter deaths index (%)
25
20
15
10
0
2001/02 2003/04 2005/06 2007/08 2009/10 2011/12 2013/14 2015/16
Year (August to July)
66.
9.8 Falls and hip fractures
Falls are the largest cause of emergency hospital Hip fracture is a debilitating condition. Only 1
admissions for older people. Falls can lead to serious in 3 sufferers return to their former levels of
injury and death, and can often result in older people independence and 1 in 3 ends up leaving their own
moving from their own homes to long-term nursing home and moving to long-term care.
or residential care.
• There were 260 emergency hospital admissions
• There were 956 emergency hospital admissions for hip fractures in Stoke-on-Trent among people
due to falls among people aged 65 and over in aged 65 and over in 2016/17.112
Stoke-on-Trent in 2016/17.111
• The rate of hip fractures has fluctuated locally
• Although the current rate of admissions in the since 2010/11, but is currently the lowest it has
city is the lowest it has been since 2011/12 been since 2011/12 (figure 38). However, the
(figure 37), it remains significantly higher than current admission rate is higher than the national
the national average (2,365.5 versus 2,113.8 per average (644.1 versus 575.0 per 100,000).
100,000).
Figure 37 Emergency hospital admissions due to falls (aged 65 and over) in Stoke-on-Trent
(2010/11 to 2016/17)
3,500
3,000
2,500
2,000
1,500
Stoke
England
1,000
500
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Year
67.
Figure 38 Emergency hospital admissions due to falls (aged 65 and over) in Stoke-on-Trent
(2010/11 to 2016/17)
900
800
700
600
500
400
Stoke
England
300
200
100
0
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Year
9.9 End of life
Compared with hospital, people in general would • The proportion of people dying at home (or their
choose to die either at home, in a hospice or a care usual place of residence) in 2017 was lower
home. Reducing the amount of deaths in hospital in Stoke-on-Trent (38.0%) compared with the
not only helps decrease the number of unnecessary national average (46.6%).113
admissions, but also helps to ensure that people’s
preferences are met as much as possible. • Between 2010 and 2017, the proportion of people
dying at home increased by 12.8% in Stoke-on-
Trent compared with a 17.4% increase across
England.114
68.
10. CREATE FAIR EMPLOYMENT
AND GOOD WORK FOR ALL
69.
CREATE FAIR EMPLOYMENT AND GOOD WORK
FOR ALL
71.6% of people (aged 16-64) are

working (England 75.2%)
29%
of people (16+) are working in
managerial and professional jobs
(England 46.5%)
6,600 19.5%
of households
people (16+)
are unemployed are ‘workless’
(England 14.0%)
11,000 people (aged 16-64) are economically

inactive due to long-term sickness
2.6% of workers had at least one day off work

due to sickness (England 2.1%)
70.
10.1 Economy • There were around 21,000 people (aged 16-64)
claiming the main out-of-work benefits in Stoke-
• The performance of the economy in Stoke-on- on-Trent (November 2016).91 This proportion
Trent (£20,763) was below regional (£22,144) (13.1%) is higher than the national average of
and national averages (£27,060), as measured by 8.1%.
the economic output indicator Gross Value Addedv
(GVA) per head of population (in 2016).115 • 44.4% of out-of-work benefit claimants in the
city had been claiming benefits for more than five
• Between 2011 and 2016, the average levels of years (similar to the England average of 45.0%).91
GVA (per head of population) increased by more
in Stoke-on-Trent (18.9%) than the national • There were 11,000 people (aged 16-64) who
average (16.5%), but by less than the regional were economically inactive in the city due to long-
average (19.4%). term sickness (June 2018), which accounts for
29.0% of all economic inactivity in Stoke-on-Trent
10.2 Employment
• In Stoke-on-Trent (June 2018), there were a
• There were 3,010 apprenticeship starts in Stoke- lower proportion of people (aged 16 and over)
on-Trent in 2016/17, with the rate of starts per working in managerial and professional jobs
head being higher in the city compared with the compared with England (29.0% versus 46.5%),
England average.116 and a higher proportion working in routine jobs
(26.0% versus 16.8%).91
• The number of apprenticeship starts in the
city has fallen over the past five years by 8.0% • The three largest sectors (in 2017) that people
compared with a 5.7% fall in England. in Stoke-on-Trent were employed in were:
human health and social work activities (20.3%
• The proportion of people (aged 16-64) working of employees), the wholesale and retail trade
in Stoke-on-Trent has increased from 65.0% in (17.8%) and manufacturing (11.9%).91
2013/14 to 71.6% in 2017/18.117 Although high,
the current rate in the city remains below the • The gap in the employment rate in Stoke-
national average of 75.2%. on-Trent between people with a long-term
health condition (aged 16-64) and the overall
• Whilst the number of jobs available locally employment rate was 27.9% in 2016/17
continues to increase, the annual rate of growth (compared with a slightly higher gap nationally of
over the past five years (2011-16) has been 29.4%).118
slower in Stoke-on-Trent compared with England
(1.5% versus 2.1% per year).91 • For people with a learning disability (aged 18-
64), the gap in the employment rate across
• One third (33.1%) of people working in Stoke-on- the city was 67.6% (compared with 68.7% in
Trent were employed on a part-time basis in 2017 England).119
(similar to the national average of 32.2%).91
• For people in contact with secondary mental
• 6,600 people (16 and over) were unemployed in health services (aged 18-69), the gap in the
Stoke-on-Trent (June 2018), which is equivalent employment rate was 67.1% in Stoke-on-Trent
to 5.4% of economically active people in the city compared with 67.4% in England.120
• The number of workless households in Stoke-on-

Trent increased from 13,600 to 15,600 between
2016 and 2017, the biggest single year on year
increase since 2004.91 The proportion of workless
households across the city in 2017 was 19.5%,
far higher than the national average of 14.0%.
Locally, this is the largest proportion since 2013.
v
In economics, Gross Value Added (GVA) is the measure of the value of goods and services produced in an area, industry or sector of an economy.
71.
10.3 A healthy workforce
Good work can be good for health. The more we do • Promoting good health at work can see a 25% to
to help and encourage people into work, and to help 40% reduction in absenteeism.
them be healthy when they are in work, the more
likely we are to have a healthier working population. In regards to sickness absence locally, the latest data
shows that:
The British Heart Foundation (BHF) has found that
healthier staff have:121 • The proportion of employees (aged 16 and over)
in Stoke-on-Trent having at least one day off work
• better morale due to sickness in the previous working week was
• take less time off work 2.6% (during 2015-17), which was slightly higher
• are less likely to leave than the England average of 2.1%.122
• perform better
• are more productive • Locally, this means that around 2,500 employees
on average had a least one day off work due to
The BHF also notes that, for employers: sickness in the previous working week (between
2015-17).
• The potential return on investment for a UK
business that invests in workplace health
initiatives is £4.17 for every £1 spent.
• An employer who actively promotes wellbeing in

the workplace is eight times more likely to have
employees fully engaged in their work.
72.
11. ENSURE A HEALTHY
STANDARD OF LIVING FOR ALL
73.
ENSURE A HEALTHY STANDARD OF LIVING FOR ALL
Average pay in the city is around
£100 lower
a week lower than the rest of England
20.8%
of people are experiencing
deprivation due to low incomes
(England 14.6%)
12,400 people
(aged 16-64) are underemployed
they would like to work more hours
16,400 people
(aged 16-64) are overemployed
they would like to work fewer hours
22% of children
(aged 0-15) live in out-of-work
benefit households (England 14.0%)
74.
11.1 Income and wages 11.2 Employment
• The average levels of gross disposable household • Across the UK, around 8% of people employed
incomevi (GDHI) per head of population (in would like to work more hours than they currently
2016) were lower in Stoke-on-Trent (£14,075) do (September 2018).124 This could mean that
compared with regional (£16,766) and national around 12,400 people (aged 16-64) in Stoke-on-
averages (£19,878).123 Trent are underemployed.
• Between 2011 and 2016, the average levels of • Levels of underemployment tend to be more
GDHI (per head of population) increased by more prevalent among people working in lower skilled
in Stoke-on-Trent (14.7%) than the national jobs, those working part-time and among young
average (13.0%), but by less than the regional people.
average (15.5%).
• Around 1 in 10 workers in the UK are
• In 2018, the gross weekly pay of someone overemployed, meaning they would like to work
working full-time in Stoke-on-Trent was £478 per fewer hours for less pay.124 This equates to
week compared with a national average of £575, a around 16,400 people in Stoke-on-Trent.
weekly difference of nearly £100.91
• 11,260 children (under 15) live in out-of-work
• Based on the Income Domain of the 2015 Indices benefit households in Stoke-on-Trent (May
of Deprivation,11 there are an estimated 52,000 2016), which is 22.0% of all local children
people in Stoke-on-Trent living in income (compared with 14.0% in England).125
deprived households (20.8% locally compared
with 14.6% in England).
vi
Gross disposable household income (GDHI) is the amount of money all individuals in a household have available to spend (or save) after taxes and
other benefits have been deducted.
75.
12. CREATE AND DEVELOP
HEALTHY AND SUSTAINABLE
PLACES AND COMMUNITIES
76.
CREATE AND DEVELOP HEALTHY AND
SUSTAINABLE PLACES AND COMMUNITIES
89% of people
were satisfied with the area as
a place to live
77% 23%
of people of people
feel safe outside after dark feel likely to be a victim of crime
Biggest problems locally
23% 21% 20%

Drugs Anti-social Alcohol
behaviour
778 households
on the Housing Register have a housing need
or urgent need
195 households
were accepted as being homeless
77.
12.1 Environment
• Stoke-on-Trent is ranked 98th (out of 326, 1 = • Compared with England, emissions of CO2 in
worst) local authorities in England in regards to Stoke-on-Trent were higher for industry (2.5
the quality of the local environment (based on the tonnes versus 1.9) but lower for transport (1.3
Living Environment Domain of the 2015 Indices of tonnes versus 1.9). Domestic emissions were the
Deprivation).11 same (1.6 and 1.5).
• Nearly one quarter (23.9%) of local areas in the • Levels of air pollution were lower in Stoke-on-
city were classified as being among the top 20% Trent compared with England in 2016 – 8.9 versus
most deprived in England in regards to the quality 9.3 micrograms per cubic metre (as measured by
of the environment. exposure to fine particulate matter, also known as
PM2.5).127
• This may in part explain why only 12.6% of
adults (aged 16 and over) in Stoke-on-Trent • During 2015/16 in Stoke-on-Trent, there were
used outdoor green space for exercise or health nearly 1,800 complaints about noise by local
reasons compared with 17.9% in England (March residents.128 Although the current rate of
2015 to February 2016).79 complaints is higher in the city than the national
average (7.1 versus 6.3, per 1,000, all ages), the
• In 2016, each person living in Stoke-on-Trent rate has more than halved locally from a high of
produced 5.3 tonnes of carbon dioxide (CO2), the 15.0 in 2011/12.
same as the England average (CO2 is the main
greenhouse gas in the UK, accounting for over
80% of UK greenhouse emissions).126
78.
12.2 Satisfaction with local area
Feeling the Difference is a longstanding public The survey examines a number of broad themes,
opinion survey giving people in Stoke-on-Trent and including: the local area, local services, safety,
Staffordshire the opportunity to share their views policing and justice, volunteering. Based on Waves
on their local area as a place to live, their safety, 21-24vii (latest Wave = March 2018), the main findings
wellbeing and local public services. The survey is for Stoke-on-Trent were:129
undertaken twice a year (March and September) with
each survey involving around 1,700 people.
Local area Local services
• 89% of people were satisfied with • 79% of people were satisfied with
their local area as a place to live the level of service provided by
• 23% reported that people using or the police
dealing drugs was a big problem • 62% were satisfied with the level
• 21% of respondents reported that of service provided by the city
anti-social behaviour was a big council
problem • 26% of respondents felt well
• 20% said that people misusing informed about the work done by
alcohol or being alcohol the police
dependent was a big problem • 33% felt well informed about the
• 6% reported that community work done by the city council
tension or discrimination was a • 9% of people had heard about
big problem their local Healthwatch
• 7% had heard about their local
Clinical Commissioning Group
Safety, policing and justice Volunteering

• 96% of people feel safe outside • 9% of people had given unpaid
during daytime help to groups, clubs or
• 77% said they feel safe outside organisations
after dark • 27% had given unpaid help to
• 8% had been a victim of crime friends or neighbours
during the last 12 months
• 23% of people said they feel likely
to be a victim of crime
• 73% of respondents agreed the
police can be relied on to be there
when needed
• 60% said the police deal
with things that matter to the
community
vii
In Waves 21-24 of Feeling the Difference, 1,801 people from Stoke-on-Trent took part.
79.
12.3 Housing 12.4 Walking and cycling
• There are around 85,000 private homes and Creating an environment where people actively
18,500 council owned properties across the choose to walk and cycle as part of everyday life can
city.130 have a significant impact on health outcomes and may
help reduce inequalities in health. It is an essential
• House prices in Stoke-on-Trent are lower than component of a strategic approach to increasing
the England average – £112,000 compared with physical activity, and it may be more cost-effective
£247,900.131 than other initiatives that promote exercise, sport and
active leisure pursuits.
• Although average house prices across the city
are lower, houses may not necessarily be more • The proportion of adults (aged 16 and over) who
affordable locally as lower wages in the city often walk for travel (on at least three days per week)
offset lower house prices, making it difficult for was 17.6% in Stoke-on-Trent (in 2016/17).127
local people to access the housing ladder. This was significantly below the national average
of 22.9%.
• The number of households on the housing • The proportion of adults (aged 16 and over)who
register with a housing need or urgent need cycled for travel (on at least three days per week)
(bands 1 and 2) in Stoke-on-Trent was 778 was 0.9% in Stoke-on-Trent (in 2016/17).127 This
(November 2018).132 was significantly below the national average of
3.3%.
• There were 195 households accepted as being
homeless (and in priority need) in Stoke-on-Trent 12.5 Public transport
in 2017/18.133 The current rate of homelessness
is lower in the city compared with England (1.8 Public transport remains a key issue for individuals
versus 2.4 per 1,000 households). and local communities, especially for people who do
not have access to a car. Whilst around 80% of UK
• 62.1% of accepted applications for homelessness households have a car, this proportion falls to 37%
came from people aged 25-44 (compared with (among people with the lowest 10% of incomes)
58.8% nationally), whilst 17.9% were from young and 53% (among people with the lowest 20% of
adults aged 16-24 years of age (compared with incomes).136 Based on the 2011 Census, 30.9% of
21.2% nationally).134 households in Stoke-on-Trent had no cars or vans
compared with 25.8% in England.137
• Just over half of accepted homelessness
applications (52.3%) in the city came from lone There are said to be three indicators of ‘transport
parent households with dependent children poverty’:138
(compared with 51.1% nationally), whilst 17.9%
came from one person households (compared • Areas of low income (where the costs of running
with 24.3% nationally).134 a car or using public transport would place a
significant strain on household budgets).
• The main three reasons given for homelessness • Areas where a significant proportion of residents
in Stoke-on-Trent in 2017/18 were: other live further than a mile from their nearest bus
relatives or friends no longer willing or able stop or railway station.
to accommodate (19.5%), loss of rented • Areas where it would take longer than an hour to
accommodation (18.5%) and required to leave access essential goods and services by walking,
accommodation by the Home Office as asylum cycling and public transport.
support (12.3%).134
Low incomes (‘affordability’) and long public
• Nationally, the main three reasons given for transport journey times (‘accessibility’) are key
homelessness in 2017/18 were: loss of rented barriers for many people in accessing essential
accommodation (27.4%), parents no longer services, including employment. Whilst access to
willing or able to accommodate (14.8%) and local buses is reasonable, it is often the relatively
other relatives or friends no longer willing or able infrequent services, slow speeds and need to change
to accommodate (12.1%). buses which can create problems.
• There is a predicted shortage of authorised gypsy Whilst the city’s off-road cycling network can still be
and traveller sites in the city which will meet the improved, access by cycling is unlikely to be a major
needs and demands of these families, both in the physical barrier for local people, with most of the city
short term and over the next decade.135 accessed within one hour.
80.
12.6 Community action
Against the backdrop of high levels of deprivation Alongside this, many different community and
and poorer health outcomes, the city of Stoke-on- residential groups across the city are involved in
Trent continues to offer much to its local people. and organising events for their local areas, whilst
The recently published Cultural Strategy139 and the city’s libraries continue to be a great source of
Community Cohesion Strategy140 highlight how the learning, education and support for people living in
city council is working together with local people to Stoke-on-Trent.
provide activities and opportunities for engagement.
81.
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(Indicator 4.05i). Public Health England. 80. Green Space Strategy. 2018. Stoke-on-
PHOF Tool Trent City Council. GS Strategy
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82. Local Alcohol Profiles for England (Indicator
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(Indicator 4.07i). Public Health England.
83. Local Alcohol Profiles for England (various
PHOF Tool
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66. Public Health Outcomes Framework LAPE Tool
PHOF Tool 84. Public Health Outcomes Framework
(Indicator 2.15iii). Public Health England.
67. Personal well-being in the UK: April 2017 to PHOF Tool
March 2018. Office for National Statistics.
Personal wellbeing 85. Opiate and crack cocaine use: prevalence
estimates by local area. Public Health
68. Quality and Outcomes Framework (QOF): England. Opiate and crack statistics
2017/18 NHS Digital. QOF
86. National Drug Treatment Monitoring
69. Projecting Adult Needs and Service System. Public Health England. NDTMS
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93. Crime Survey for England and Wales:
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(Indicator 3.03xiii). Public Health England. 125. Children in out-of-work benefit households.
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110. Excess winter mortality in England and Industrial Strategy. CO2 emissions
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85.
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for National Statistics. Car ownership
(Indicator 1.14i). Public Health England. 135. Newcastle-under-Lyme, Stoke-on-Trent,
PHOF Tool Staffordshire Moorlands and Stafford
Gypsy and Traveller and Travelling
129. Feeling the Difference Survey. Staffordshire Showperson Accommodation
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Lyme Borough Council, Stoke-on-Trent City
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140. Stoke-on-Trent Community Cohesion

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Trent City Council. CC Strategy
86.
APPENDIX
Main findings
Population
• Around 255,400 people live in Stoke-on-Trent. • For women in the city, HLE was 58.7 years
• 51,800 (20.3%) are children aged 0-15. compared with 63.8 years in England. This means
• 43,200 (16.9%) of people are aged 65 and over. that 72.7% of a woman’s life in Stoke-on-Trent is
likely to be spent in good health (compared with
• There are around 3,300 live births each year in 76.7% in England).
the city.
• Men and women living in the most deprived areas
• 23.5% of births are to mothers from Black and of the city have a HLE which is around 13 years
Minority Ethnic groups. lower than those living in the most affluent areas
of the city.
• The city is becoming increasingly ethnically
diverse: the ‘Non-White British’ population has Best start in life – from birth to age five
increased from 6.4% in 2001 to an estimated 20.2%
• 23.8% of children (under 16) are living in poverty
in 2016.
in Stoke-on-Trent (16.8% in England) – which is
around 12,400 children.
• Stoke-on-Trent is the 14th most deprived local
authority in England (out of 326).
• 9.5% of local babies had a low birthweight (below
2,500 grams) compared with 7.3% in England.
• 136,200 people in the city live in areas classified
as being among the top 20% most deprived in
• The infant mortality rate in Stoke-on-Trent is the
England.
highest in the country. On average, one infant dies
Overarching measures of health every two weeks in the city (during their first year
of life).
Life expectancy is one of the key measures of a
population’s health, and refers to the number of years • 18.2% of local women smoked during pregnancy
a person can expect to live. – the lowest it has been locally – compared with
10.8% in England.
• Life expectancy (at birth) for men in Stoke-on-
Trent is 76.5 years compared with 79.6 years in • Levels of breastfeeding (in the first 48 hours after
England. delivery) and at 6-8 weeks are both lower in Stoke-
on-Trent compared with England (60.1% versus
• Life expectancy for local women is 80.8 years 74.5% for the first 48 hours, and 27.1% versus
compared with 83.1 years in England. 42.7% for breastfeeding at 6-8 weeks).
• Locally, life expectancy has remained unchanged • Childhood immunisation rates across the city are
since 2010-12 for men and since 2012-14 for generally high, with over 90% of local children
women. being vaccinated against the main diseases.
• Life expectancy is 9.6 years lower for men and 6.4 • Just under one third of children aged five in the city
years lower for women living in the most deprived were suffering from tooth decay, which is far higher
areas of Stoke-on-Trent compared with those than the national average of 23.0%.
living in the most affluent areas of the city.
• At the end of Reception (4-5 year olds), two
Improving life expectancy is not only about adding thirds of schoolchildren in Stoke-on-Trent were
years to life, it’s also about adding quality to life. considered ‘ready for school’ (similar to the
Healthy life expectancy (HLE) is an estimate of the England average of 70.7%).
number of years someone would expect to live in good
health.
• HLE for men in the city was 59.5 years compared

with 63.4 years in England. This means that 77.8%
of a man’s life in Stoke-on-Trent is likely to be
spent in good health (compared with 79.7% in
England).
87.
Developing well – childhood into young Living well – working age adults
adulthood • Around 2,500 people die each year in Stoke-on-
Trent – cancer (28.7%), circulatory disease (23.0%)
• 40,000 pupils attend local schools in the city – 8,000
and respiratory disease (16.1%) are the three major
claim free school meals.
killers.
• 8,200 pupils do not have English as a first language.
• 2,500 pupils have a learning disability.
• Nearly one quarter of local deaths are considered
‘preventable’.
• At Key Stage 2 (10-11 year olds), 58% of pupils
in Stoke-on-Trent met the expected standards in
• Premature morality rates (under the age of 75) from
reading, writing and maths (65% in England).
the three leading causes of death – cancer, circulatory
disease, respiratory disease – continue to fall locally.
• At Key Stage 4 (15-16 year olds), 53.3% of pupils
in Stoke-on-Trent achieved a 9-4 pass (including
• Overall levels of mental wellbeing continue to
English and Maths) compared with 59-1% in
improve across the city.
England.
• The prevalence of dementia, epilepsy and other
• The proportion of 16-17 year olds who were not in
severe mental health conditions were higher locally
education, employment or training (NEET) was 4.4%
compared with England.
locally compared with 6.0% in England.
• There are around 24,700 adults (aged 18-64) with a
• 19.2% of Reception schoolchildren (4-5 year olds)
common mental health disorder (such as anxiety and
in Stoke-on-Trent were overweight or obese – the
depression) in the city.
lowest it has been locally – compared with 22.4% in
England.
• The suicide rate has fallen dramatically locally and is
now below the national average.
• 37.1% of Year 6 schoolchildren (10-11 year olds)
in the city were overweight or obese (34.3% in
• There were 900 emergency hospital admissions for
England).
intentional self-harm – this rate is increasing locally.
• Levels of smoking, exposure to secondhand smoke,
• There were an estimated 3,800 local adults (aged 18-
drinking and drug use have all fallen locally among
64) with a learning disability.
pupils in Stoke-on-Trent in recent years.
• 20.7% of adults (aged 18 and over) smoke in the city –
• There were 4,700 referrals to children’s social care
the lowest it has been.
locally – referral rates continue to increase across
the city.
• Around 9 people die each week in the city due to
smoking.
• There were 3,200 children in need locally.
• Two thirds of adults (aged 18 and over) are
• There were 740 looked after children (LAC) across
overweight or obese in Stoke-on-Trent, which
the city – the local LAC rate is double the national
equates to around 131,000 local people.
average.
• 55.6% of food outlets in Stoke-on-Trent are fast food
• 12.8% of 5-19 year olds were estimated to have a
outlets compared with 38.4% in the UK.
mental health disorder, which equates to around
5,900 children and young people.
• 92,000 people (aged 16 and over) do not eat the
recommended five portions of fruit and veg a day
• There were 302 hospital admissions for self-harm
across the city.
among children and young adults aged 10-24 –
admission rates continue to increase across the city.
• 54.1% of local adults (aged 19 and over) met the
recommended weekly levels of physical activity
• Hospital admission rates for unintentional and
compared with 66.0% in England.
deliberate injuries among local children aged 0-14
continue to fall in the city.
• 30.9% of local adults were physically inactive (22.2%
in England), which equates to around 60,300 people.
• The number of teenage conceptions (among 15-17
year olds) has fallen dramatically in the city from 219
• 12.6% of adults (aged 16 and over) used outdoor
in 2012 to 116 in 2016 – a fall of 47%.
green space in the city for exercise or health reasons.
• There were 86 first time entrants across the city to
the Youth Justice System in 2017 compared with 208
in 2010 – a fall of 59%.
88.
• Levels of mortality and hospital admissions for Ageing well – healthy older people
alcohol are higher in Stoke-on-Trent compared with
England across a number of outcomes. • By 2030, the numbers of older people aged 65 and
over in Stoke-on-Trent are projected to increase by
• Locally, 44% of adults (aged 18 and over) are around 9,300, to 52,400. This means that 1 in 5 local
estimated to be drinking at levels of increasing or people will be aged 65 and over by 2030 (compared
higher risk, which equates to around 87,200 people. with 16.9% currently).
• 21.9% of alcohol users successfully completed • By 2030 there will be increasing numbers of older
treatment locally compared with 38.9% in England. people in the city with: limiting long-term illnesses,
dementia, depression, falls, unable to manage one
• Around three people die each week in the city due self-care activity/domestic task/mobility activity,
to alcohol. providing unpaid care.
• There are higher rates of opiate and crack users • The prevalence of the most common long-term
locally, along with lower levels of opiate/non-opiate conditions – hypertension, depression, diabetes,
users successfully completing treatment compared asthma and chronic kidney disease – are all higher in
with England. the city compared with England.
• A higher proportion of local people (27.4%) in drug • There were around 3,600 requests for support from
treatment (aged 18 and over) were in contact with new clients (aged 65 and over) to adult social care in
the criminal justice system compared with England the city in 2017/18 – an average of 10 requests every
(20.9%). day.
• Around 32,000 local people have received an NHS • Over 3,300 adults (aged 65 and over) accessed long-
Health Check. term funded social care support in the city.
• 12.3% of adults (aged 16-64) have no formal • There was a higher rate locally (for people aged 18
qualifications in the city compared with 7.6% in and over) of delayed transfers of care from hospital.
England.
• Two thirds of service users (aged 18 and over) in
• Just under one quarter of local people (23.4%) Stoke-on-Trent were satisfied with the care and
were qualified to NVQ level 4 and above (38.3% in support they received from social services.
England).
• 61.6% of local users said their quality of life was good
• Around 23% of local employers said they had staff (similar to the national average).
that were not fully proficient due to skills gaps (in
2015) compared with the England average of 14%. • 28.8% of local users felt they did not have enough
choice over the care and support services they
• There were around 30,000 recorded offences in received (25.8% in England).
Stoke-on-Trent in 2017/18, an increase of more than
9,500 since 2012/13. • 2.7% of local users did not feel safe (compared with
1.8% in England).
• The rate of people killed and seriously injured on
roads in Stoke-on-Trent is lower than the national • 70.1% of carers (aged 18 and over) who received
average. support or services in Stoke-on-Trent were satisfied
whilst 14.3% were dissatisfied.
• 18.2% of local carers had some worries about their

personal safety (15.9% in England).
• 6 out of 10 people cared for by local carers were aged

65 and over.
• 36.0% of local carers had a longstanding illness

themselves (28.6% in England).
• Around 6,600 older people (aged 65 and over) in the

city were estimated to be experiencing loneliness.
89.
• 17,200 households in Stoke-on-Trent were estimated Ensure a healthy standard of living for all
to be in fuel poverty, which equates to around 39,000
local people. • Between 2011 and 2016, the average levels of
gross disposable household income (per head of
• 7 out of 10 local people (aged 65 and over) had population) increased by more in Stoke-on-Trent
received their flu jab; 3 out of 10 had not. (14.7%) than the national average (13.0%).
• There were 190 excess winter deaths (all ages) in • The gross weekly pay of someone working in
Stoke-on-Trent in 2016/17, the highest number Stoke-on-Trent was £478 per week compared with
locally since 2008/09. a national average of £575, a weekly difference of
nearly £100.
• There were 956 emergency hospital admissions
due to falls and 260 emergency admissions for • There are an estimated 52,000 people living in
hip fractures locally among people 65 and over in income deprived households in Stoke-on-Trent
2016/17. (20.8% locally versus 14.6% in England).
• The proportion of people dying at home (or their • 12,400 people (aged 16-64) in Stoke-on-Trent were
usual place of residence) in 2017 was lower in Stoke- underemployed – they would like to work more
on-Trent (38.0%) than the national average (46.6%). hours.
• 16,400 people (aged 16-64) in Stoke-on-Trent were

Create fair employment and good work for all overemployed – they would like to work fewer hours.
• There were 3,000 apprenticeship starts in Stoke-on- • Around 11,300 children (aged 0-15) live in out-of-
Trent in 2016/17, although the number of starts has work benefit households in Stoke-on-Trent, which is
fallen by 8% over the past five years (compared with 22.0% of all local children (compared with 14.0% in
a 5.7% fall in England). England).
• 71.6% of people (aged 16-64) are working in Stoke-

on-Trent (75.2% in England).
Create and develop healthy and sustainable
places and communities
• One third of people working in the city are employed
part-time. • The city is ranked 98th (out of 326, 1 = worst) local
authorities in England in regards to the quality of the
• 6,600 people (aged 16 and over) were unemployed local environment.
in the city (June 2018).
• Nearly one quarter of local areas in the city were
• There were around 15,600 workless households in classified as being among the top 20% most
the city. This proportion (19.5%) is far higher than deprived in England in regards to the quality of the
the national average of 14.0%. environment.
• 21,000 people (aged 16-64) were claiming the main • 89% of people were satisfied with the local area as a
out-of-work benefits in the city (November 2016). place to live.
• 11,000 local people (aged 16-64) were • The biggest problems locally were: drug dealing
economically inactive due to long-term sickness. (23%), alcohol (20%) and anti-social behaviour
(21%).
• 29.0% of local people (aged 16 and over) were
working in managerial and professional jobs (46.5% • 77% of local people feel safe outside after dark.
in England).
• 23% of local people said they feel likely to be a
• 2.6% of employees in the city had at least one day victim of crime.
off work due to sickness in the previous working
week compared with 2.1% in England. • There are around 85,000 private homes and 18,500
council owned properties across the city.
• There were 778 households on the housing register

with a housing need or urgent need.
• 195 households were accepted as being homeless

across the city in 2017/18.
90.
• 17.6% of adults (aged 16 and over) in Stoke-on-
Trent walk to work (22.9% in England); 0.9% of
local people cycle to work (3.3% in England).
• 30.9% of households in Stoke-on-Trent had no cars

or vans compared with 25.8% in England (based on
the 2011 Census).
91.

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Stoke-on-Trent

Joint Strategic Needs Assessment

16.9% are aged 65 and over

14th most deprived local authority in England (out of 326)

OVERARCHING MEASURES OF HEALTH

Life expectancy in most deprived areas 9.6 years less

Average 80.8 years 83.1 years in England

Life expectancy in most deprived areas 6.4 years less

one baby dies every

7,952 have free school meals

2,523 have a learning disability

58% of Key Stage 2 pupils (10-11 year olds)

12.8% Teenage pregnancies

2,500 deaths 24,674

28.7% 23% 16.1%

not eat enough

3,595 requests for

260 emergency admissions

of service users were

71.6% of people (aged 16-64) are

11,000 people (aged 16-64) are economically

2.6% of workers had at least one day off work

Average pay in the city is around

Biggest problems locally

23% 21% 20%

To give greater context to these themes, two

Figure 1 Social determinants of health

mic , cultural and e

Age, sex and

Figure 2 2017 population estimates for Stoke-on-Trent

• Although women in Stoke-on-Trent live longer

• Men and women living in the most deprived areas

one baby dies every

Figure 4 Children (under 16) living in poverty in Stoke-on-Trent (2006-2015)

Source: Public Health England 2018

Figure 6 Infant mortality rates in Stoke-on-Trent (2001-03 to 2015-17)

Figure 7 Smoking in pregnancy in Stoke-on-Trent (2010/11 to 2017/18)

Figure 8 Childhood immunisations in Stoke-on-Trent (2017/18)

6.8 School readiness

7,952 have free school meals

2,523 have a learning disability

58% of Key Stage 2 pupils (10-11 year olds)

12.8% Teenage pregnancies

Figure 10 Schoolchildren overweight or obese in Stoke-on-Trent (2006/07 to 2017/18)

• Just under half (49.0%) of LAC who had been in

• The number of admissions locally has increased

• The under 18 conception rate in Stoke-on-Trent

7.17 Reoffending 7.18 Road traffic accidents

• Nationally, levels of reoffending have increased

2,500 deaths 24,674

28.7% 23% 16.1%

not eat enough

Figure 25 Wellbeing outcomes (aged 16 and over) in Stoke-on-Trent (2017/18)

Figure 26 Wellbeing outcomes (aged 16 and over) in Stoke-on-Trent (2017/18)

Figure 27 Prevalence of patients on GP registers with mental health conditions in Stoke-on-Trent

• The suicide rate has fallen in Stoke-on-Trent from

8.9 Learning disabilities

Other findings from the survey show that:72

Figure 30 Prevalence of smoking (aged 18 and over) in Stoke-on-Trent (2012-2018)

2014 and 2015 figures