WCC Submission 30.11.08

Barnet Joint Strategic Needs Assessment
2008/11
Subjectto approvalby BarnetPCT/BarnetCouncil
Adult Strategy Group and BarnetPCT Board
NHS
Barnet
Primary Care Trust
NHS
Barnet
Primary Care Trust
NHS
Barnet
Primary Care Trust
NHS
Barnet
Primary Care Trust

2008/11
CONTENTS
Summary i
Acknowledgements iii
1 Introduction 1
2 Creating a health-supporting environment: First things first 2
Barnet: overview 2
2.1 Barnet’s population 2
2.1.1 What are the implications of these population changes? 11
2.2 Housing 12
Improving access to quality health services 17
Reducing unscheduled care 17
2.3 The effect of deprivation and ethnicity on health 18
2.3.1 The effect of ethnicity on health 22
2.3.2 Other aspects of diversity 24
2.4 Employment 24
2.5 Crime 27
2.6 The views of local residents 28
2.6.1 Travelling further for GP services 30
2.6.2 Respect and Dignity 30
2.6.3 Recent use of NHS services 31
2.6.4 Maternity and Newborn Care 33
3 Improving health and wellbeing: enabling healthy choices for a healthy life, and
supporting independence and building resilience 34
3.1 Introduction 34
3.1.1 The main causes of ill-health death 35

3.2 Immunisation 38
3.2.1 Overview 38
3.2.2 The risk we face 38
3.2.3 The relationship between diversity and deprivation and infectious disease 41
3.2.4 Local targets 41
3.2.5 Key things that need to be done 42
3.3 Smoking cessation 43
3.3.1 Overview 43
3.3.3 The relationship between diversity and deprivation and smoking-related
disease 44
3.4 Coronary heart disease and stroke: preventing vascular disease 46
3.4.1 Overview 46
3.4.3 The relationship between diversity and deprivation and CVD 48
3.4.6 The ‘Finding the 5000’ project 51
3.5 Cancers 56
3.5.1 Overview 56
3.5.3 The relationship between diversity and deprivation and cancer 57
3.5.6 Screening 61

3.6 Respiratory disease 62
3.6.1 Overview 62
3.6.3 The relationship between diversity and deprivation and respiratory disease 65
3.7 Diabetes 66
3.7.1 Overview 66
3.7.3 The relationship between diversity and deprivation and diabetes 68
3.8 Sexual health 70
3.8.1 Overview 70
3.8.3 The relationship between diversity and deprivation and sexual health
problems 75
3.9 Mental health problems 78
3.9.1 Overview 78
3.9.3 The relationship between diversity and deprivation and mental health
problems 80
3.10 Obesity 81
3.10.1 Overview 81

3.10.3 The relationship between diversity and deprivation and obesity 84
3.11 The views of local residents 85
3.11.1 Overview – Perception of health 85
3.11.1 Healthy lifestyle 86
3.11.2 Alcohol consumption in Barnet 87
3.11.3 Healthy eating 88
4 Investing in independence 91
4.1 Overview 91

i
2008/11
Summary
Whilst Barnet is a prosperous and generally healthy borough, many of its residents are
affected by health and social inequality. For example, there is a difference in life
expectancy for males at birth of up to some seven years between those who live in the
most affluent parts of the borough compared with those in the most deprived; for females
this difference is up to seven years. Whilst women generally live longer than men, it is
the life expectancy difference within the sexes of those living in different parts of the
borough that is significant. Put another way, people living in the more deprived parts of
the borough are more likely to experience poorer health and are more likely to die
prematurely. It is also important to note that there is evidence that, overall, Barnet has
become relatively more deprived in the last few years. If this trend continues, we can
expect Barnet residents’ health to worsen unless we take action to reduce the risk
factors for avoidable ill-health.
A major cause of the geographical differences in life expectancy in Barnet, as elsewhere,
is differences in lifestyle factors such as smoking and obesity. People living in moiré
deprived areas are more likely to smoke and are more likely to be overweight and obese.
The burden on the health and social care services caused by this is substantial and thus
may be considered to be an issue that goes beyond personal choice as it impacts on
service need and thus the PCT’s and the council’s ability to provide services for the
whole population. Encouraging and enabling people to avoid unhealthy lifestyles is thus
an important role for the PCT and the council.
Barnet’s population is expected to grow substantially over the coming five years, with the
largest increase occurring in people aged 45-64 years. This ‘middle aged spread’ is
especially important: people of this age are more likely to develop avoidable risk factors
for a number of diseases and screening for breast cancer, high blood pressure, high
blood cholesterol, kidney disease and diabetes will need to become a more prominent
and regular feature of health care if we are to detect and manage risk factors before
significant damage occurs.
With an increase in the borough’s population of possibly some 40,000 people, and a
consequential rise in the proportion of children and of women of childbearing age over
the next few years, it will also be necessary to review the capacity of education and
maternity services to meet the population’s needs.
The proportion of Barnet’s population who come from Black and minority ethnic groups is
also expected to change. It has increased in recent years from about 25% to 31.5% and
is likely to reach 35.7% by 2017. People from Black and minority ethnic groups often
have different cultural, social and religious values and their health and social needs can
only be met properly if our services are tailored to those differences.

ii
Over the next few years, in terms of health services, Barnet needs to:
 increase childhood immunisation rates;
 increase breast and bowel cancer screening rates;
 identify and adequately manage more people with risk factors for heart attack and
stroke;
 increase (despite the recent and current good performance) the number of people
who quit smoking;
 reduce the proportion of children who are overweight and obese;
 reduce the proportion of adults who are overweight and obese;
 increase the number of young people screened for genital Chlamydia infection;
 further reduce the number of teenagers who have unplanned pregnancies.

iii
2008/11
Acknowledgements
The creation of this document would not have possible without the help of the following
people:
Annette Alcock
Alison Blair
Alice Bolton
Andrew Burnett
Mary Caporizzo
Dadia Conti
Christine Cornwall
Steve Craker
Diane Curbishley
Eryl Davies
Shindi Dhillon
Julia Duke-MacRae
Hester Fairgrieve
Cynthia Folarin
Alison Hardacre
Chloe Horner
Glynis Joffe
Kanan Kannan
Peter Keeble
Kate Kennally
Susan Otiti
Lance Saker
Vilish Shah
Paul Shipway
Jill Stansfield
David Thomas
Noreen Twomey
Val White

1
2008/11
1 Introduction
This joint strategic needs assessment identifies the ‘big picture’ in terms of health and
well-being1
of the residents of Barnet and people registered with Barnet GP practices. Its
purpose is to provide a basis for the development of health and social care services so
that they can promote health and well-being more effectively and so that:
 services are shaped more by local communities;
 inequalities can be reduced; and
 social inclusion can be increased.
This version builds on the Barnet Health Profile 2007/08. It is a draft document that
covers the main health service issues including a number of health improvement areas.
Further work will be undertaken to add sections expanding on social care needs.
This Barnet Joint Strategic Needs Assessment for 2008-11 has been drawn up by
Barnet Council and Barnet PCT. It will inform future iterations of:
 the Barnet Sustainable Community Strategy;
 the Barnet Local Area Agreement;
 the Children and Young People’s Plan;
 the Commissioning Framework for Health and Wellbeing;
 the Barnet PCT Commissioning Strategy Plan;
 the Barnet PCT Local Delivery Plan; and
 various strategies and polices, including –
 housing,
 regeneration,
 community safety,
 supporting people,
 supporting carers,
 community safety,
 workforce planning,
 practice-based commissioning initiatives,
 community pharmaceutical services development.
Joint strategic needs assessments draw on national, regional and local datasets as well
as the outcomes of local consultations and views expressed by community
representatives and individuals at meetings such as the Barnet Civic Network and formal
groups such as the Barnet Local Strategic Partnership and the Barnet Adult Strategy
Group.

2
2 Creating a health-supportingenvironment: Firstthings first
Barnet: overview
Barnet is a prosperous and generally healthy borough. Its residents are more likely to be
owner-occupiers than are others in London, with proportionately fewer living in the social
rented sector. However, like many places, Barnet has areas of deprivation where there
are above-average death rates in people aged under 75 years, and with others living in
those areas experiencing generally poorer health. Generally, life-expectancy is greater in
Barnet than in many other parts of London and the rest of the country but, as elsewhere,
there are differences in life expectancy between different parts of the borough.
Barnet is home to some 335,000 people, based on Office for National Statistics (ONS)
projections. Some 350,000 people are registered with Barnet GPs. The difference
between these figures is that some people who live just outside the borough choose to
register with GPs whose practice areas lie mainly within it and thus are the responsibility
of Barnet PCT. (Similarly, some Barnet residents register with GPs whose practice areas
are mainly outside the borough.)
A snapshot of Barnet:
 covering 87 square kilometres, Barnet is London’s fourth largest borough in size;
 28% of the land in Barnet is green belt (2,466 hectares) and 8% is metropolitan open
land (690 hectares). There are also 200 parks and open spaces;
 it is the second most religiously diverse borough in the country and with 31.5% of its
population belonging to a black and minority community, the 20th most ethnically
diverse;
 results in our primary and secondary schools place Barnet in the top quartile
nationally;
 this high education attainment is also evident across the adult population; over 37%
are qualified to at least HND, degree and higher degree level;
 crime levels per head of population are lower in Barnet than the national average.
Fear of crime, however, remains high;
 71% of houses in Barnet are owner-occupied;
 37% of Barnet working-age residents travel to work by public transport
 Barnet has a large share of knowledge workers – those in managerial, professional
and technical jobs – relative to the national average;
 there were over 14,780 VAT-registered businesses at the end of 2006, the third
largest in London;
 each resident produces around 431kg of waste each year and Barnet as a whole
produces 1892 tonnes of CO2 emissions per year.
2.1 Barnet’s population
Barnet’s resident population has a similar age-structure to the rest of London, but there
are some important differences. A common way of showing the age-sex structure of a
population is with a population pyramid. Error! Reference source not found. shows the
age-sex structure of the populations of Barnet and London.

3
Figure 1: Population pyramids for Barnet and London showing the numbers of people by
age band (Source: Office for National Statistics 2006 mid-year estimate)
However, because the populations of the two areas are different in size (note that the
scales are different on the horizontal axis) it is difficult to tell what, if any, differences there
are. Figure 2 therefore shows the populations of Barnet and London expressed as
proportions of the total population in each age band and these are compared directly in
15000 10000 5000 0 5000 10000 15000
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
males females
400000 200000 0 200000 400000
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
males females
BARNET LONDON
Age
bands
Number of people Number of people
15000 10000 5000 0 5000 10000 15000
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
males females
400000 200000 0 200000 400000
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
males females
BARNET LONDON
Age
bands
Number of people Number of people

4
Figure 3.
Figure 2: Population pyramids for Barnet and London showing the proportion of people in
the total population by age band (Source: Office for National Statistics 2006 mid-year estimate)
6 4 2 0 2 4 6
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age
bands
Proportion of total population (%)
6 4 2 0 2 4 6
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age
bands
males females
males females
BARNET LONDON
6 4 2 0 2 4 6
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age
bands
6 4 2 0 2 4 6
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age
bands
males females
males females
BARNET LONDON

5
Figure 3: A direct comparison of the proportions of people in both Barnet and London in
each age band (Source: Office for National Statistics 2006 mid-year estimate)
6 4 2 0 2 4 6
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age
bands
males females
LONDON and BARNET
The grey dotted line shows the proportion of
people in each age band in Barnet
6 4 2 0 2 4 6
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age
bands
males females
LONDON and BARNET
The grey dotted line shows the proportion of
people in each age band in Barnet

6
Figure 3 shows that there are proportionately fewer men in the age band 20-44 years in
Barnet than in London, and fewer women (age band 20-40 years). This is especially
relevant in terms of maternity services provision: Barnet’s current population has
proportionately fewer women of child-bearing age than the rest of London, although this is
set to change, as described below. It is also relevant in terms of employment. Many
employed people are in the age band 20-44 years.

7
Figure 3 also shows that Barnet has proportionately more children of school-age and
more middle-aged and older people than the rest of London. This has implications for
school and health services.
In the next few years, Barnet’s population is expected to increase through natural growth
and because more people will move into the borough because of a substantial increase
in the number of homes being built. Population projections made by the Office for
National Statistics (ONS) take account of death and fertility rates, and make
assumptions about internal migration (people moving from one part of the country to
another), but do not include the anticipated population growth due to Barnet’s
regeneration programme. Population projections made by the Greater London Authority
(GLA) use a slightly different calculation method but do factor in the proposed
regeneration growth.
Table 1 shows the proportionate increase expected in Barnet’s population over the
measured population in the 2001 census. Both ONS and GLA figures are shown.
Table 1: The proportionate growth predicted in Barnet’s population
Age band
(years)
2001
Census
2013
(ONS)
2013
(GLA)
Projected population change
between 2001 & 2013 (%)
ONS GLA
0-14 60,043 70,000 64,660 17 8
15-44 142,027 149,400 163,077 5 15
45-64 67,000 82,400 83,634 23 25
65-74 22,809 25,300 23,982 11 5
75+ 22,685 24,700 22,506 9 -1
Figure 4 shows these same figures graphically. The most striking feature is that whether
the ONS or GLA projection method is used, we can expect the biggest increase in the
population to be amongst people aged 45-64 years. This ‘middle-age spread’ is
important because it is at this age that many significant risk factors for cardiovascular
disease become apparent and when a number of cancers that be identified by screening
become more likely. The main risk factors for cardiovascular disease, other than
smoking, are raised blood pressure, raised blood cholesterol and diabetes, all of which
are more likely in people who are obese. People should not be complacent about this; it
is very easy to move from being overweight to being obese and this risk increases with
overweight and obesity, it does not suddenly happen when someone reaches a certain
weight for their height. Whilst smoking is a risk at any age, overweight and obesity
become more common in middle age. If the health and social care services are to help
people to reduce the risk of cardiovascular disease then there will be more work to do
with more people in Barnet as the population gets bigger – in both senses of the word –
especially in this age group. In addition, the risk of developing breast cancer and
colorectal cancer starts to increase at this age. Thus, with the biggest increase in

8
Barnet’s population over then next few years being in the middle-age group, services will
need to be developed to cope with more people needing more lifestyle risk assessments
and interventions if we are to reduce morbidity and mortality from a number of diseases.
Figure 4: The proportionate growth predicted in Barnet’s population Source: Office for
National Statistics and Greater London authority
-5%
0%
5%
10%
15%
20%
25%
30%
0-14 15-44 45-64 65-74 75+
Age Group (years)
Projected
population
change
between
2001
and
2013
(%)
Office for National Statistics projection
Greater London Authority projection
-5%
0%
5%
10%
15%
20%
25%
30%
0-14 15-44 45-64 65-74 75+
Age Group (years)
Projected
population
change
between
2001
and
2013
(%)

9
Figure 5: Planned regeneration projects in Barnet and projected consequential population
growth (Source: Barnet Council Information Observatory)
Figure 5 shows where the main regeneration projects are planned in the borough and
how many additional people are expected to move into these areas.
Barnet has the second highest number of people over 65 in Greater London. There has
been a steady increase in the number of people who are living to the age of 75 years in
Barnet, and this growth will be compounded when the post war generation (referred to
as the baby boomers) will, by 2020, begin to reach 75 years old. Associated with this
will be an increase in the number of older people from Black and minority ethnic groups,
with the sharpest increase expected to occur in Indian, Chinese and Black African
groups2
.
High
Barnet
Totteridge
West
Finchley
Underhill
Hale
Edgware
Childs Hill
Golders
Green
Barnet Hospital
Finchley Memorial
Hospital
Edgware
Community
Hospital
Royal Free Hospital
Brunswick Park
Oakleigh
Woodhouse Coppetts
East Barnet
Mill Hill
Finchley Church End
West Hendon
Garden Suburb
East Finchley
Hendon
Colindale
Burnt Oak
Index of Multiple
Deprivation Score
21.4 to44.9
14.9 to21.4
11.9 to14.9
9.2 to11.9
4 to9.2
Dollis Valley
1,850 people
Mill Hill Barracks
6,250 people
Grahame Park
4,150 people
Adastral Site
548 people
RAF East Camp
3,650 people
West Hendon
3,500 people
Cricklewood/Brent Cross
16,000 people
Stonegrove
1,925 people
High
Barnet
High
Barnet
Totteridge
West
Finchley
Underhill
Hale
Edgware
Childs Hill
Golders
Green
Barnet Hospital
Finchley Memorial
Hospital
Edgware
Community
Hospital
Royal Free Hospital
Brunswick Park
Oakleigh
Woodhouse Coppetts
East Barnet
Mill Hill
Finchley Church End
West Hendon
Garden Suburb
East Finchley
Hendon
Colindale
Burnt Oak
Index of Multiple
Deprivation Score
21.4 to44.9
21.4 to44.9
21.4 to44.9
14.9 to21.4
14.9 to21.4
11.9 to14.9
11.9 to14.9
9.2 to11.9
9.2 to11.9
4 to9.2
4 to9.2
4 to9.2
Dollis Valley
1,850 people
Dollis Valley
1,850 people
Mill Hill Barracks
6,250 people
Mill Hill Barracks
6,250 people
Grahame Park
4,150 people
Adastral Site
548 people
RAF East Camp
3,650 people
Grahame Park
4,150 people
Grahame Park
4,150 people
Adastral Site
548 people
Adastral Site
548 people
RAF East Camp
3,650 people
RAF East Camp
3,650 people
West Hendon
3,500 people
West Hendon
3,500 people
16,000 people
16,000 people
Stonegrove
1,925 people
Stonegrove
1,925 people

10
At the same time, the number of people living beyond 85 years of age is set to increase.
GLA projections for the years 2007 to 2017 shows an increase of approximately 1,100
people. Although this increase is small, in terms of overall population growth, there will
be a significant impact on the demand for services, due to the higher number of complex
high-dependency conditions more frequently found in this age group. However, this
projected increase in older people aged 85+ years is expected to occur only in 11 out of
21 wards. The biggest absolute increase is expected in Colindale (131) and West
Hendon (113).
Figure 6 and Table 2 show the ONS projections for the 65, 75 and 85 + age groups for
the years 2004 to 2029.
Figure 6 Estimate of the population growth in the 65, 75 and 85+ year old age groups
(000’s) 2004-2029
Source: Office for National Statistics
Table 2: Estimate of the population growth in the 65, 75 and 85+ year old age groups
(000’s) 2004-2029
Age 2004 2005 2006 2007 2008 2009 2014 2019 2024 2029
65+ 45.5 45.5 45.4 45.2 45.5 46.1 50.3 53.9 58.7 65.1
75+ 22.8 23.0 23.3 23.2 23.2 23.3 24.3 25.6 29.5 32.4
85+ 6.6 6.8 6.9 7.0 7.1 7.2 7.6 8.3 9.4 10.5
As the population for older people increases, so will the number of older people living on
their own. Approximately 18,000 (31%) of older people in Barnet live alone and due to a
higher rate of divorce in the 50+ age group the number of older people living alone is set
to increase. Older people who live alone, and who are in poor health, are more likely to
require help from sources other than their family. Social changes of this nature are very
likely to increase the demand for social care and health services. However, there is
strong evidence that social networks make a contribution to healthy ageing. Creating
the opportunities for people to socialize and to become involved in local voluntary
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2014 2019 2024 2029
65 years+
75 years+
85 years+
Projected
population
(thousands)
in
each
age-group
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2014 2019 2024 2029
65 years+
75 years+
85 years+
65 years+
75 years+
85 years+
Projected
population
(thousands)
in
each
age-group

11
networks will be an important factor in prolonging the well-being and independence of
older people who live alone.
During 2005, the Office for National Statistics announced that life expectancy at the age
of 65 was at its highest ever in the UK and that, on average, men aged 65 could expect
to live a further 16.6 years, and women a further 19.4 years, if mortality rates remain the
same as they were in 2003-05. Women will continue to live longer than men, but the
gap has been closing in recent years. In 1983-85 there was a difference of 4 years
between male and female life expectancy at age 65 in the UK (13.2 and 17.2 years
respectively). By 2003-05 this had narrowed to 2.8 years. The implication of this is that
historically women have spent a larger proportion of their final years in poor health. This
difference in the number of years over which, older males and females experience poor
health may become less obvious as life expectancy for men increases. On the other
hand, as more people can be expected to live beyond 90 years of age, so an increase in
the prevalence of limiting long-term conditions is also very likely to increase.
Audit Commission data shows that 15% of residents aged over 60 years of age live in
households that are income deprived. This is slightly higher than the national mean and
is near the average for London, where the range is 23.1% (Brent) and 9.9% (Bromley)3
.
A Joseph Rowntree Foundation study of the material resources of older people found
that women, persons living alone, those that are widowed, divorced or separated, poorly
educated are disproportionately represented in the lower socio-economic groups and to
be in poor health.4
A recent analysis of the location of people aged 85+ shows there are pockets of older
people at a variety of locations within the borough. This is significant in terms of the
targeting of selected geographical areas to reduce the impact of undue poverty on the
demand for social care and health services due to: social isolation, depression, poor
nutrition or hypothermia.
2.1.1 What are the implications of these population changes?
More people will require more services as Barnet’s population grows and they will need
different services at different ages. For example, Figure 4 shows that Barnet is expected
to have more children and women of childbearing age in the next few years. This means
that there will be a need for more family planning and sexual health services; more
maternity services; more pre-school provision; more school places; and more health and
social care for children and families. To enable the increased number of adults in this
age-group to be better able to support themselves and their families, the borough will
also need to encourage and enable more employers to offer job opportunities.
However, the biggest change in Barnet’s population will be in the number of people aged
45-64 years. This ‘middle-age spread’ will have particular significance for long-term
conditions: these people are the most likely to develop obesity, raised cholesterol, high
blood pressure, diabetes, stroke and heart disease.
Addressing this issue is important if we are to use the resources available to the
commissioners and providers of health and social care effectively. In his final report on
the nation’s health in 2004, Derek Wanless predicted that the proportion of the country’s
wealth required to fund the health system would rise inexorably unless both the
population and the health and social care services became ‘fully engaged’ in health
improvement: an additional £30bn would be required each year by 2022, for example.5

12
Wanless described three ‘scenarios’, one being of ‘slow progress’ in both the general
public and the NHS being involved in more health-improving behaviour. He predicted
that such ‘slow progress’ will result in the NHS requiring an increasing proportion of the
country’s wealth to deal with an increasing amount of illness. This is shown in Figure 7.
But much of this illness is avoidable. Wanless’s second scenario, that of ‘solid progress’,
showed that there would still be an increasing amount of the country’s wealth required to
support health care but this would be much less after about 2012. However, significantly,
Wanless predicted that with ‘full engagement’ by both the general public and the NHS in
health-promoting behaviour, the proportion of the country’s wealth required to support
the NHS would level off by 2017.
Figure 7: The expenditure required for health care services as a proportion of gross
domestic product in each of Wanless’s three scenarios6
Significantly, Wanless observed that “The more engaged [people are in improving their
health], the more often people will use primary care and self care as opposed to
secondary or acute care…”5
So, the healthier we become as a result of our own actions
and the encouragement and enablement of the health services and local authorities, the
proportionately cheaper the NHS will be to provide health care for those who need it.
This will reduce the need for higher taxation to support the NHS.
2.2 Housing
In the 2001 Census, only 7.3% of Barnet residents described their health as ‘not good’
which is lower than that of both London (where 8.1% described their health as ‘not
good’) and England (9.2%). However, there is a clear association between reported ill-
health and housing tenure, as shown in
fully engaged
slow uptake solid progress
1977-78 1982-83 1987-88 1992-93 1997-98 2002-03 2007-08 2012-13 2017-18 2022-23
5
6
7
8
9
10
11
12
13
Proportion
of
GDP
(%)
fully engaged
slow uptake solid progress
1977-78 1982-83 1987-88 1992-93 1997-98 2002-03 2007-08 2012-13 2017-18 2022-23
1977-78 1982-83 1987-88 1992-93 1997-98 2002-03 2007-08 2012-13 2017-18 2022-23
5
6
7
8
9
10
11
12
13
5
6
7
8
9
10
11
12
13
Proportion
of
GDP
(%)

13
Table 3, poorer health is more common amongst those living in social housing.

14
Table 3: Reported ill-health in relation to housing tenure
Tenure Total households
Households reporting
ill-health
Proportion of
households reporting
ill-health (%)
Owner-occupied, no
mortgage
40,576 301 0.74
Owner-occupied,
with mortgage
48,434 1,207 2.49
Privately rented 20,371 1,567 7.69
Registered social
landlord rented
6.035 536 10.64
Council-owned
property rented
11,008 1,684 15.29
Source: London Borough of Barnet Housing Needs Assessment, Fordham Research, 2006
Barnet Council considers that a good quality and secure home provides the basis for
good health, and there are a number of ways in which the housing services provided by
the council and its partners contribute to this. For example, the council is landlord to
some 15,000 tenants and leaseholders, many of whom are on low incomes and are
vulnerable. In addition, the council provides about 2,500 temporary homes to homeless
people and a housing benefits service to about 27,500 people on low incomes. It is likely
that the clients that the council provide services to suffer from a higher incidence of poor
health, and the circumstances that lead to poor health.
Older people in Barnet make up 21% of the population as a whole and 75% of these
households own their own property without a mortgage. Seventy-five per cent of older
owner-occupiers live in three or four bedroom properties. Many of these households are
asset rich, but cash poor, and struggle to maintain their homes. National research has
shown that the majority of older people would prefer to either remain living in their home,
or would prefer accommodation which is part of the ordinary housing stock but suitable
to meet their needs through design. Older people increasingly expect a high standard of
accommodation, with a spare room for visitors, a study and car parking facilities.
Leasehold sheltered/retirement housing in Barnet is generally provided by the
independent sector, where existing properties tend to be in the more affluent areas of
the Borough. A number of new schemes are planned and this may be an indication that
the supply is not yet sufficient to meet demand. People moving into such schemes are
likely to be downsizing from larger properties, and therefore access to funding is not
significant issue. What may be significant is the type of support and care that is based
on site in the private schemes and a comparison with the type of product on offer for
tenants in terms of care and support and where possible the strategy needs to refer to
the research being carried out by the independent sector and /or commission
A survey by Housing Needs Survey (HNS) found that 5.7% of single pensioner and 8.1%
households were living in unsuitable housing. The main reasons for unsuitability were
described as accommodation being too expensive, restricted mobility which may be due
to health reasons and the accommodation being subject to major disrepair or unfitness

15
these were some of the issues identified. Another issue which affected older people was
they were experiencing difficulty maintaining their home.
In 2006, the HNS survey data revealed that fewer than 5% of older people living in the
borough had difficulty maintaining their home, and they defined this as a problem. In
addition 0.48% indicated that this was a serious problem.
A major concern for older people during the winter months is the ability for them to keep
warm during the winter months. This is highlighted annually when the Department of
Health campaign Keep Warm Keep Well is aimed at financially disadvantaged older
people or disabled people and their carers.
Nevertheless, it is worth noting the number of older person households without central
heating. Table 4 indicates the figures collected at the last census. The proportion of
such households was just over 7%. i
Table 4: People aged 65 and over by age (65-74, 75-84, 85 and over) living in a dwelling
with no central heating, year 2001
Total 65 and
over
population
Number of 65
and over
population
with no
central
heating
Percentage of 65
and over
population with
no central heating
(%)
People aged 65-74 22,809 1,392 3.06
People aged 75-84 15,626 1,207 2.65
People aged 85 and over 7,059 626 1.38
Total population aged 65 + 45,494 3,225 7.09
Figures may not sum due to rounding. Crown copyright 2007
Figures are taken from Office for National Statistics (ONS) 2001 Census, Standard Tables,
Table SO54 Shared / unshared dwelling and central heating and occupancy rating by age.
Figures in this table have not been projected forward as the figures would not be reliable.
Barnet’s Sustainable Communities Plan recognises the council’s contribution to
improving the health and well being of its residents needs and to focus on three areas:
 health improvement;
 improving access to quality health services; and
 reducing unscheduled care.
i The number of council homes without central heating will have reduced through the decent
homes programme. The private sector stock condition survey due late 2008 will provide an
update.

16
Table 5 sets out some of the existing contributions that Housing Services in Barnet make
towards some of the borough’s health priorities and identifies areas for further work.
Table 5 Current and potential contributions by Housing Services in Barnet to improving
health
Health improvement
Existing Activities Potential
Tackle environmental factors
underlying health and well
being
 Decent Homes Programme
(includes HH&S legislation
assessment on safety within
the home)
 Estate Regeneration Schemes
 Improvements to thermal
efficiency of council dwellings
 Tackling decent homes in the
private sector, inc.
improvements to thermal
efficiency
 Housing Health and Safety
Rating System to tackle poor
housing conditions in the
private sector
 HMO registration scheme
 Providing more suitable
temporary accommodation for
households with dependant
children.
 Reducing the use of temporary
accommodation
 Working with Housing
Associations to provide high
quality new affordable homes
 Application of lifetime
homes standard for new
homes
Health Promotion/Education  West Hendon Healthy living
Day July 07
 Barnet Homes Healthy eating
programme
 Fire safety campaigns (LPSA
concluded March 06)
 Barnet Homes Health and
Safety Promotion (Nov 06)
 Targeted
campaigns/information
using Barnet Homes
tenant newsletter and
other communications
(inc. translations and
interpreting as
appropriate)

17
Table 5 continued
Health improvement
Existing Activities Potential
Supporting Healthier Life
Styles
 Barnet Homes Gardening
Scheme
 West Hendon healthy sports
weeks in August 07 for under
11's
 Barnet Homes Silver Surfers
Scheme
 Barnet Homes Youth Group
Dancing
 Analysis of correlation
between poor health and
social housing
 Research into access to
health services and
physical activity
Improving access to quality health services
Champion the Needs of
Local Communities
 Older persons housing needs
strategy group (includes
representation from the PCT)
 Tenant/Leaseholder
consultation framework
 Residents associations
Use Planning policy to
support PCT Community
and Primary Care
developments
 Consultation with residents on
regeneration estates on
planned health facilities
Targeted Client Groups  Falls prevention in sheltered
housing
 Exercise classes in sheltered
housing
 Nottingham University project
on water softeners and
eczema
 Development of
Sheltered Housing as
community resource
 Providing better
information on local
health services to
homeless people and
new tenants
 Identify specific needs of
BME communities
Reducing unscheduled care
Improved planned care  Adaptations
Reduce unscheduled care  Lifeline and Telecare schemes
 Housing Support Officers
 Fire safety checks carried out
by Barnet Homes

18
2.3 The effect of deprivation and ethnicity on health
Data from the decennial census are used to construct an ‘index of multiple deprivation’.
This includes factors such as employment status, the proportion of working age adults
with no or low qualifications, household overcrowding, houses without central heating.
The relative levels of deprivation in Barnet’s 21 electoral wards is shown in Error!
Reference source not found..
There is a close relationship between poor health and deprivation. This is shown clearly
by death rates in people aged under 75 years, as shown in Figure 9.
Figure 8 Relative deprivation levels in Barnet at an electoral ward level
Source: Office for National Statistics data
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
Woodhouse
Coppetts
Underhill Oakley
Brunswick
Park
East
Barnet
High Barnet
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
Woodhouse
Coppetts
Underhill Oakley
Brunswick
Park
East
Barnet
High Barnet
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
West
Finchley
Woodhouse
Woodhouse
Coppetts
Underhill Oakley
Brunswick
Park
East
Barnet
High Barnet
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low

19
Figure 9: The relationship between death rates in people aged under 75 years and
deprivation levels at an electoral ward level.
Figure 9 shows that in areas with a higher deprivation score, death rates are
correspondingly higher. However, these data have been compiled at an electoral ward
level. If one looks at census ‘super output areas’, i.e. subdivisions of electoral wards, it is
apparent that the borough is a patchwork of different levels of deprivation.ii
This is shown
in Figure 10.
Many of the more deprived areas shown in Figure 10 coincide with housing estates and
areas of social housing. As will be seen in section 3.4.6, focusing on these small areas
of relatively high deprivation is more likely to enable commissioners of health and social
care services to improve people’s health: it is here that, generally, more people with
more poor health risk factors live, and many of these people are less likely to recognise
any need to do anything to address these.
Recently published government data shows that Barnet is more deprived in relation to
other local authority areas than in 2004. It now has six census superoutput areas that
are in the most deprived centileiii
in the country; previously there were none.
It is difficult to make exact comparisons in deprivation between different years because
the precise way the government defines its index of multiple deprivation (IMD) changes,
although these changes are not necessarily great. The IMD consists of a number of
ii Census data is compiled from individual household returns.Much data is collated into electoral wards, but
some is made available at sub-ward (‘census super output’) level. In Barnet, an electoral ward covers an
average population of about 15,000 people. The average super output area covers some 1,500 people.
Analysis at this scale shows thatdeprivation,for example,is not confined to large areas in limited parts of
the borough butthat there is a patchwork of deprivation and affluence of differentdegrees nestled together
across the borough.That said,there is a greater preponderance ofdeprivation in certain areas and wards.
Deprivation tends to be highest in certain estates, such as Grahame Park, Brunswick Park and Stone
Grove.
iii A centile is a group of ten. Proportions can be expressed as percentages, i.e. as a number of
one hundredths. The metrics being measured, e.g. people’s height, the proportion of children
achieving 5 grade Cs in GSCE exams can be ranked in numerical order and then grouped in a
number of ways, such as in tenths
400
500
600
700
800
900
1000
1100
1200
1300
10 15 20 25 30 35
Index of Multiple Deprivation (2007)
Standardised
all-cause
mortality
in
people
aged
under
75
years
per
100,000
400
500
600
700
800
900
1000
1100
1200
1300
10 15 20 25 30 35
Index of Multiple Deprivation (2007)
Standardised
all-cause
mortality
in
people
aged
under
75
years
per
100,000

20
measures including some from the census; some from educational data (e.g. average
test scores at Key Stage 4 and GCSE results); data on road traffic accidents; modelling
to estimate ‘difficulty of access to owner-occupation; measures of the proportion of
households for whom a decision has been made on applications for homeless provision
assistance; and health data including GP prescribing data, hospital episode statistics,
and average distance from a GP surgery.
The new figures show Barnet to be more deprived than in 2004 in relation to other
boroughs in both London and England. This worsening is the largest such change
nationally. Of 354 English local authorities, Barnet now ranks the 128th
most deprived
(65 more so than in 2004) and 21st
out of the 33 London boroughs, three places worse
than in 2004 (1 = most deprived). Barnet is thus more deprived than most local
authorities in England but less deprived than most London ones.
It is important to note that the change in Barnet’s position is relative because the
measures used have been changed. It does not necessarily mean that Barnet has
become more deprived in absolute terms; it is possible that Barnet is becoming less
deprived but that other boroughs are improving at a greater rate.
Figure 10: Relative deprivation levels in Barnet at census superoutput area level
Source: Office for National Statistics data
Edgware Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
Underhill
Oakley East
Barnet
High Barnet
West
Finchley
East
Finchley
Coppetts
Totteridge
Mill Hill
Woodhouse
Brunswick
Park
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
Edgware Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
Underhill
Oakley East
Barnet
High Barnet
West
Finchley
East
Finchley
Coppetts
Totteridge
Mill Hill
Woodhouse
Brunswick
Park
Edgware Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
Underhill
Oakley East
Barnet
High Barnet
West
Finchley
West
Finchley
East
Finchley
East
Finchley
Coppetts
Coppetts
Totteridge
Mill Hill
Woodhouse
Brunswick
Park
Brunswick
Park
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low

21
Whenever new data show something surprising it is necessary to question their accuracy
and then to look for other possible causes. Possibly the most significant factor to
consider is the actual population. As most measures are based on the actual number for
each metric divided by the borough’s population, an artificially low denominator
population will tend to increase the measure and an artificially high one will tend to
decrease it. Any measure based on census returns will become increasingly inaccurate
over time (e.g. the number of people living in overcrowded premises, the number of
people with no or low qualifications), as will any modelling based on such data, e.g. the
Table 6 shows the relative changes that occurred in the main measures of deprivation in
Barnet between 2004 and 2007.
Table 6 : Average ranks in different deprivations measures at superoutput level
IMD measure
Average rank of Barnet’s
superoutput areas
(out of 32,482 nationally)
NOTE 1 = most deprived
Change:
2004 to 2007
2004 2007*
Barriers to housing and services (wider) [including the
proportion of households for whom a decision has been made
on applications for homeless provision assistance]
4,916 1,012 3,904
Living environment (outdoors) [incl. air quality, road traffic
collisions]
7,963 7,449 514
Crime [burglary, violence, theft, criminal damage] 15,075 12,959 2,116
Income [recipients of means-tested benefits] 16,127 15,021 1,106
Living environment (indoors) [incl. social & private housing in
poor condition, houses without central heating]
16,566 16,319 247
Employment [Jobseekers Allowance and Incapacity Benefits
claimants, New Deal Scheme participants]
20,461 18,741 1,720
Barriers to housing and services (geographical) [incl.
distance from services, e.g. GP surgery, post office]
19,217 18,787 430
Health and disability [incl. hospital statistics.] 23,767 23,193 573
Education (skills) [proportion of working-age adults with no or
low qualifications]
26,684 26,703 + 19
Education (children and young people) [incl. Key Stage
scores and staying-on rates]
23,419 31,350 + 7,931
Average rank (out of 32,284) 18,755 14,610 4,145
* Where the ranking for 2007 has become smaller this reflects a worsening of the position, i.e. a move
towards higher deprivation.
The data in Table 6 suggest that, over the last three years, deprivation in Barnet has
increased especially, albeit not to a great extent, in terms of more applications for
homeless provision, an increase in crime and fewer people being in employment. On the
other hand, educational achievements have improved by a relatively large amount.

22
These changes, which affect a number of superoutput areas rather than the whole
borough, are unlikely to be especially significant in terms of the need for future health
and social care services unless there are further changes in the same direction.
2.3.1 The effect of ethnicity on health
Barnet is the twentieth most ethnically diverse borough in England with 31.5% of its
residents belonging to Black and minority ethnic groups. This is an increase of 5.5%
since 2001, a trend that is projected to continue, with 35.7% of the population belonging
to a Black and ethnic minority group by 2017.
Error! Reference source not found. shows the relative proportions of people in Black
and minority ethnic groups in different parts of the borough.
Figure 11: The proportion of people from Black and minority ethnic groups as a proportion
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
Woodhouse
Coppetts
Underhill Oakley
Brunswick
Park
East
Barnet
High Barnet
Proportion of ward
population from
Black and minority
ethnic groups (%)
>29
27 – 29
26 – 27
21 – 26
11 – 21
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
West
Finchley
Woodhouse
Woodhouse
Coppetts
Underhill Oakley
Brunswick
Park
East
Barnet
High Barnet
Proportion of ward
population from
Black and minority
ethnic groups (%)
>29
27 – 29
26 – 27
21 – 26
11 – 21
Proportion of ward
population from
Black and minority
ethnic groups (%)
>29
27 – 29
26 – 27
21 – 26
11 – 21

23
People from Black and minority ethnic groups often have different health needs. There
are several reasons for this. Some diseases are relatively specific to certain ethnic
groups. For example, sickle cell disorder (a disease affecting the haemoglobin in red
blood cells) occurs mainly in people in Black ethnic groups, whilst thalassaemia (a
different condition affecting haemoglobin) mainly occurs in people from Asian and
Mediterranean (especially Greek and Turkish) ethnic origin.
Another example of a disease affecting people differently is diabetes. This is more
common amongst people from Asian and African-Caribbean ethnic origin,7
and death
rates from the disease and from its complications is higher in these people.
Similarly, high blood pressure and one of its most important complications – stroke – is
more common amongst people of Black ethnic origin.8,9
Such people are also more likely
to die if they have a stroke, making the control of high blood pressure all the more
important,10
but cultural differences also mean that different approaches are needed in
addressing these issues in different groups.11
Two aspect of mental health, and thus the type of care that is needed, are especially
noteworthy in the context of ethnic differences. Schizophrenia is diagnosed more
commonly in people of African Caribbean origin than in people from other ethnic
groups.12
And rates of suicide and of deliberate self-harm are higher among young Asian
women than in the White population.13
It is not clear why these differences occur, but
they do reflect the need for services to be both flexible and culturally sensitive.
Another reason that people from Black and minority ethnic groups have different health
and social care needs is because, for many of them, their cultural values and religious
beliefs are different from those of the indigenous population. A further aspect of this is
the different incidence of certain diseases in their countries of origin. For example, breast
cancer is relatively uncommon amongst Asian women in the sub-Asian continent but its
incidence among them rises when they emigrate to the west. In addition to having
different cultural values and beliefs about cancer, they may also consider themselves to
be at low risk of breast cancer because it was an uncommon disease amongst their
parents’ and grandparents’ contemporaries. This has implications for how breast
screening services are organised and promoted.
A number of other issues affect the health and social care needs of people from Black
and minority ethnic groups. For many, English is not their first language, so they may
not understand some of the nuances of English any more than those whose first
language is English would understand theirs. And many refugees and asylum seekers
are escaping repression and/or physical abuse or worse and are reluctant to seek help
from ‘officials’, including people in the health and social care services. The effect of this
is that a ‘traditional’ approach by health and social care services is unlikely to serve them
in the best way. But a service that is better orientated towards their values can be. This
means that services need to be developed at a local level – and to engage community
leaders – if we are to provide care in a way that can be used effectively.
In Barnet, the largest numbers of people from Black and minority ethnic groups are
Asian and Black African. Whilst a proportionately small group, Barnet is home to the
largest Chinese population in London. And, although a religious rather than an ethnic
group, Barnet is home to the largest Jewish population in the country.

24
2.3.2 Other aspects of diversity
There are six equality and diversity ‘strands’. These are:
 age;
 gender;
 ethnicity;
 disability;
 religious belief; and
 sexual orientation.
There is legislation requiring those providing public services to take reasonable steps to
avoid direct and indirect discrimination on the grounds of age, gender, ethnicity and
disability. There is also an increasing expectation that those providing public services
should also avoid direct and indirect discrimination on the grounds of religious belief and
sexual orientation.
Most people can imagine examples of direct discrimination, for example refusing to
provide someone with a service because of their ethnic group, or refusing to employ
someone (irrespective of their ability) because of their age. Indirect discrimination is less
easy to understand but can be equally unfair. For example, providing information in
leaflets in a small typeface could indirectly discriminate against people with visual
disability: they may be unable to read it; placing lift controls high up could discriminate
against wheelchair users: they may be unable to reach the higher buttons.
Monitoring potential discrimination can, in part, be achieved by recording different factors
about people, e.g. age, gender, ethnicity and then checking to see what proportion of
people with these different factors are accessing services, or being offered jobs. There
are several problems with this, however. the first is that such data have not been
routinely collected in the past and, for some equality strands, are still not routinely
collected, e.g. sexual orientation. In part this is because it has not been recognised as
an issue, and in part it is because some people are embarrassed to ask. The second is
that it is not always apparent what the relevance of such data might be. Whilst one may
assume that the use of particular services should be the same for people in a proportion
that is equal to their representation in the population is this always the case? Some
diseases are more common in one gender, for example gallstones in women and
abdominal aortic aneurysms in men. Some conditions are more common in some ethnic
groups, e.g. diabetes in Asians and high blood pressure in African-Caribbeans.
However, it is also more common, proportionately speaking, for Black Africans, and
especially African-Carribeans to be compulsorily admitted to mental health units, yet it is
unclear if people from these ethnic groups have a predisposition to severe mental illness
or are more likely to be diagnosed with a severe mental illness perhaps because of
some cultural difference.
2.4 Employment
Nearly three-quarters (72.8%) of people aged 16 years and over in Barnet are
economically active, which is slightly less than the London average (75.2%) and the
national average (78.7%).14
This may be a reflection of education in Barnet and more
students staying on to take higher qualifications: in 2007, only 11.2% of Barnet’s

25
population had no qualifications, whilst the London average was 12.8% and the national
average was 13.1%15
. In 2006, 54.4% of Barnet’s working-age population was qualified
to NVQ Level 3 or higher and 39.3% to Level 4 or above. Barnet Council is committed to
increasing this still further and has included this as a target in the 2008-11 Barnet Local
Area Agreement with the Government Office for London.
It is also noteworthy that, on average, Barnet residents earn more than the national
average, albeit less than the London average. This is shown in Table 7.
Table 7: Gross weekly pay by residence (2007)
Barnet (£) London (£) Great Britain (£)
Full-time workers 548.90 553.30 459.00
Male full-time workers 626.10 596.00 500.70
Female full-time workers 479.10 506.00 394.80
There are proportionately more male Barnet residents who are economically active than
female (78.2% vs. 67.2%) and this also differs from the London average (82.1% vs.
67.7%) and the national average (83.3% vs. 73.7%). Again, as the definition of being
economically active includes all people aged 16 and over, this is likely to be related to
those still in education in Barnet, and the gender difference is likely to reflect a higher
proportion of women being in child and adult carer roles.
In 2001, 27% of people aged between 60 and 74 years were in work. Recent changes
in employment legislation mean that people need not retire at 65, but the effect this will
have remains to be seen. It is not unreasonable, however, to assume that older people
on low incomes, or who have poor pension prospects, will work on and that the income
will be used for essential expenses, rather than improved quality of life.
However, in parts of Edgware, Colindale, Burnt Oak, Brunswick Park and East Finchley,
more than 25% of the working-age population relies on state benefits. Barnet Council is
committed to reducing this and has included this as a target in the 2008-11 Barnet Local
Area Agreement. There is also a close relationship between deprivation and higher
proportions of people being on state benefits.
Barnet council aims to assist young people to access a broad range of education,
training and employment opportunities through targeted support and improved access in
order to develop and broaden their skills.
ONS data for economic activity in Barnet shows that between April 2006 and March
2007 Barnet’s rate (75.8) was slightly higher than the rest of London (75.0), but lower
than England (78.6). There is a similar trend for employment rate Barnet (71.2, London
(69.3) and England (78.6). The unemployment rate in Barnet (6.2) is therefore lower
than London (7.6), but higher than for England (5.5)

26
Figure 12: Trend in people aged 16-24 years claiming Jobseekers Allowance in Barnet
0
200
400
600
800
1000
1200
1400
2001 2002 2003 2004 2005 2006 2007
Figure 13: Trend in people aged 16-24 years claiming Jobseekers Allowance in London
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
2001 2002 2003 2004 2005 2006 2007
Figure 14: Trend in people aged 16 -24 year old claiming jobseekers allowance in England
0
50000
100000
150000
200000
250000
300000
2001 2002 2003 2004 2005 2006 2007
Figure 12, Figure 13 and Figure 14 show trends people aged 16-24 years claiming
Jobseekers Allowance in Barnet, London and nationally. It appears that Barnet is
following a similar trend to London and that, at present, there is no real evidence that
any relative increase in deprivation in Barnet (see section 2.3 and Table 6) in terms of
unemployment amongst younger people.

27
2.5 Crime
Crime has a harmful effect on communities both through its actual impact and fear of
becoming a victim. Currently, fear of crime exceeds the chances of becoming a crime
victim. Barnet council has prioritised activities to reduce crime and reassure the
community that crime is being tackled. Crimes that cause the most concern in the
community are: alcohol disorder; household burglaries; young people as offenders and
victims of crime; robbery; motor vehicle crime; violent crime; and drugs.
Figures 15 and 17 shows the crime trends in London, whilst figures 16 and 18 show the
crime trends in Barnet. Most types of crime are reducing, although there is little change
in burglary, and drug-related crime continues to increase.
Figure 15 Crime trends in London
Figure 16: Crime trends in Barnet from 2004 to 2008
0
1000
2000
3000
4000
5000
6000
7000
8000
Violence against
Person
Burgulary Offences against
Vehicles
Criminal Damage Drug Offences
2004/5
2005/6
2006/7
2007/8
0
50000
100000
150000
200000
250000
Violence
against Person
Burgulary Offences
against
Vehicles
Criminal
Damage
Drugs
2004/5
2005/6
2006/7
2007/8

28
2.6 The views of local residents
A wide range of consultations and Citizen’s Panel surveys are undertaken in Barnet.
The Citizen’s Panel consists of a ‘core group’ of 1,000 residents aged 18 year s and
over, and a ‘hard-to-reach group’, the latter being residents who are traditionally viewed
as being less likely to take part in this type of consultation exercise. The core panel is
intended to be representative of the adult population of the whole borough based on
ward, age, gender, ethnicity, disability and socio-economic status and was recruited by
rando selection across all wards from the Local Land and Property Gazetteer by
telephone and by face-to-face approach on Barnet’s streets.
Hard-to-reach groups consist of 150 people from Black and minority ethnic groups
recruited via postal survey targeting ethnic groups within electoral wards (super output
areas) and targeted face-to-face interviews, and 100 residents with long-term illnesses
or disability recruited through postal surveys, targeted face-to-face interviews and
through Barnet Voluntary Service Council, Barnet's umbrella group for voluntary
organisations.
The Citizens' Panel response rate to being surveyed is 42%, which is above the average
for postal surveys.
Barnet PCT has also undertaken consultations concerning proposals to develop clinical
services at Barnet and Chase Farm hospitals and proposals for London-wide health
services development. These surveys were undertaken in shopping malls and centres,
special public meetings and at the Friern Barnet Show.
Seven hundred and forty two residents also completed a Better Health for Barnet survey
this year. More women responded than men (67% vs. 28% [note that the respondent’s
gender was unrecorded in 5% of cases]) and this varies slightly from the proportion of
men and women in Barnet’s population (52% vs. 48%). The proportion of people in
different age groups, in comparison with the proportions in Barnet’s population, is shown
in Table 8.
Table 8: Ages of respondents to the Better Health for Barnet survey and the proportion in
Barnet’s population
Age group Under 25 25-34 35-44 45-54 55-64
65 and
over
Not stated
Number of
respondents
123 74 120 90 103 201 19
Proportion of
all respondents
17% 10% 16% 12% 14% 28% 3%
Number in
Barnet’s
population
105,400 53,600 54,000 42,000 33,600 46,000 -
Proportion of
population
31.5% 16% 16% 12.5% 10% 14% -
Table 8 shows that there were proportionately fewer younger respondents and
proportionately more older respondents than in Barnet’s population.

29
The proportion of people in different ethnic groups, in comparison with the proportions in
Barnet’s population, is shown in Table 8Table 9.
Table 9: Ethnicity of respondents and the proportion in Barnet’s population
Ethnic group White
Black or
Black
British
Asian or
Asian
British
Mixed Chinese Other
Not
stated
Number of
respondents
473 81 107 17 9 18 37
Proportion of
all respondents
64% 11% 15% 2% 1% 2% 5%
Number in
Barnet’s
population
228,263 28,280 49,302
Not
8,606 20,150 -
Proportion of
population
68% 8% 15% Collected 3% 6% -
Table 9 shows that respondents were reasonably representative of Barnet’s population
in terms of ethnicity.
Of those who answered the question, out of 742 respondents, 103 said that they were
registered disabled and 533 said that they were not.
An Ipsos MORI survey was also undertaken on proposals for developing London-
wide health services following the publication of Lord Darzi’s report Healthcare for
London: A Framework for Action. The report described changes to services from a
patient’s view point to make them safer and more accessible.
Again, and out of 140 respondents, more women than men responded (66% vs.
33%) but there was a different age distribution, as shown in
Table 10: Ages of respondents to the Healthcare for London survey
Age group Under 25 25-34 35-44 45-54 55-64
65 and
over
Number of
respondents
5 18 29 26 29 34
Proportion of all
respondents
4 13 21 18 21 24
There was a slight, relative under-representation of White people amongst respondents,
but otherwise they were broadly representative of Barnet’s population from an ethnicity
perspective. Twenty-three respondents stated that they were registered disabled.
A health survey was also undertaken in Hendon, but as there were only 44 respondents,
this cannot be considered to be representative of local residents in that area.

30
2.6.1 Travelling further for GP services
Respondents were asked if they would be prepared to travel a little further to see a
GP, if they were able to receive a wider range of services, including blood tests,
outpatient clinics and other specialist clinics and a majority said that they would be or
might be willing to do so, as shown in Table 11.
Table 11: Willingness of respondents to travel further for a wider range of GP and
specialist services
Yes No Maybe No Response
316 247 146 33
43% 33% 20% 4%
Specific comments from respondents who indicated that they are prepared to travel
included:
 To reduce waiting times for appointments e.g. blood tests, I don't mind travelling a
little further
 Most important that you receive the care you need even if it means travel
 It should reduce the number of visits and time needed
 As a diabetic pensioner, these services seem appealing
 Having one visit rather than multiple
 I would travel further if I knew I would receive a better service with more on offer
 Providing I saw my same doctor each time and it was run on the lines of a good
practice with added services
Specific comments from respondents who indicated that they were NOT prepared to
travel included:
 Local should be better
 Too difficult to get there, do not want to travel further
 I have a good GP service, and wouldn't want to change it.
 I do not want to lose the relationship I have with my GP who is aware of my illness
and knows me.
 Perfectly satisfied with current pattern of hospital services.
 We are happy with the excellent service provided in our practice.
 Too old to make travelling an option.
2.6.2 Respect and Dignity
Respondents were asked who they would contact if they had a concern about health
services.

31
Table 12: Responses to the question ‘Who would you contact if you had a concern about
health services?
Other responses included: teacher, local medical committee, British Medical Association,
Genera; Medical Council, receptionist, police, newspaper, NHS Direct. It is noteworthy
that no one said that they would contact the Patient Advice and Liaison Service (PALS),
which is present in every PCT, acute and mental health trust and which receives a large
number of contacts from patients and relatives. It seems that there is still some way to
go in helping people to understand how to engage with the health service.
It is noteworthy that three respondents stated that they would not complain because they
were afraid and felt vulnerable; this was because they still were required to see the
health professional for their care. One stated “it might rebound on me (being punished).”
Another stated that she would not know who to complain to and that “access to such
contacts has proved very difficult in her experience.” Whilst one respondent said “I
wouldn’t really mind how I was treated. I’m grateful to have them treat me anyway.
The responses by people from Black and minority ethnic groups were generally the
same as those from White ethnic groups.
2.6.3 Recent use of NHS services
Respondents were asked if they had used particular NHS services in the preceding 12
months. The responses are shown in Table 13.
Manager Don’t know PCT Chief
Exec
GP or
Doctor
Matron /
Ward Sister
PALS Relative /
Friend
128 82 78 77 71 66 35
17% 11% 11% 10% 10% 9% 5%
MP
Complaints
Dept
Wouldn’t
Social
Services
Voluntary
Organisation
Other
Did not
answer
18 14 12 8 8 25 120
2% 2% 2% 1% 1% 3% 16%

32
Table 13: Responses to the question ‘Have you or your family used any of the services
below provided by the NHS within the last year?’
Ipsos MORI Better Health in Barnet
Number of
completed
responses
proportion
of
completed
responses
(%)
Number of
completed
responses
proportion
of
completed
responses
(%)
None of these 40 28 - -
Long-term conditions 39 28 109 15
Acute Care 36 26 - -
Children and young people 21 15 75 10
Planned Care 16 11 55 7
Maternity and newborn care 16 11 79 11
Staying healthy (e.g. smoking
cessation clinics)
13 9 33 4
Mental Health 11 8 50 7
Prefer not to say 9 6 61 8
End of life care 5 4 8 1
A&E - - 254 34
GP - - 584 79
Pharmacy - - 471 64
Dentist - - 307 41
Optician - - 303 41
Walk-in centre - - 222 30
Total sample size 141 742
- indicates that this category was not included in the survey.
It is noteworthy that 79% of respondents said that hey had used GP services in the
preceding year. This is consistent with research evidence: 80-90% of people have
contact with their GP surgery every year. It is also noteworthy that about two-thirds
of respondents used a community pharmacy. This is less in keeping with research
evidence that shows that people use community pharmacies more frequently than
GP surgeries. It is possible that respondents in this survey were referring to seeking
health advice from pharmacists whilst other research has identified people using
pharmacists for any purpose. However, the key point is that most people use primary
care services rather than specialist secondary and mental health care services.

33
2.6.4 Maternity and Newborn Care
The Healthcare for London survey found that a number of factors were important to
users of maternity services. These are shown in Table 14.
Table 14: Relative importance of different aspects of maternity services to service users
Number of
responses
Proportion of all
responses (%)
Giving birth in a midwife-led unit with a doctor-
led unit on the same hospital site
40 58
Having a senior doctor present on the unit
where you will give birth
39 57
Being given a choice of home birth 29 42
Time taken to travel to the place where you
will give birth
29 42
Giving birth in a doctor-led unit in a hospital 21 30
Giving birth in a midwife-led unit in the
community
14 20
The survey also found that women preferred to see their midwives at home for an
appointment after the birth of their baby 45 (65%) rather than travel to their GP or
health clinic for an appointment 17 (25%), even if midwives could spend more time
with them at the GP surgery or health clinic.
Healthcare for London informed respondents that the majority of care for children,
including urgent care would continue to be provided locally. However, it was
proposed that specialist care for children would be concentrated in hospitals with
specialist child care units, which would mean that they could be situated further away
from some people’s homes. Table 15 shows the responses to this proposal, which
seem to suggest that people’s views were split equally on this issue.
Table 15: Views on the proposal to site some child care services in specialist units
Number of responses
Proportion of all
responses (%)
Strongly agree 11 12
Tend to agree 35 39
Neither agree nor disagree 11 12
Tend to disagree 17 19
Strongly disagree 12 13
Don’t know 4 4

34
3 Improvinghealth and wellbeing: enabling healthychoices for a
healthy life, and supporting independence and building
resilience
3.1 Introduction
In this section we look at how we can improve our health and wellbeing by focusing on
our own responsibility to maintain good health. The determinants of health include
lifestyle factors such as smoking, physical inactivity and obesity. Barnet Council and
Barnet PCT believe that individuals and the community have a key role to play in
improving their own health whilst influencing and encouraging the rest of the community
to do so, using local networks.
The foundations set out in the Government’s White Paper Our Health, Our Care, Our
Say16
proposed helping people stay healthy and independent whilst providing choice in
their care services and to tackle inequalities in health. As a result, Barnet Council and
Barnet PCT seeking to commission care that encourages independence, promotes
greater choice and that will help communities to develop local networks of support which
can improve health and wellbeing, as well as encouraging people to live independently
as long as possible.
Barnet’s Community Strategy17
outlines its vision on improving the social, economic and
environmental well-being of the borough. It focuses on four key themes:
 investing in children and young people
 a safer, stronger and cleaner Barnet
 growing successfully
 a healthier Barnet (including sub theme: older people).
The government continues to emphasise the importance of tackling ‘health inequalities’,
i.e. significant differences in health and well-being and access to health care that still
exist between different groups in our society. There are differences in life expectancy,
hospital admission rates, the risk of serious accidents and the risk of death from illness
in different parts of the borough. Differences in life expectancies in different parts of the
borough are shown in Figure 17.

35
Figure 17: Life expectancy at birth by gender and by electoral ward for Barnet
Source: London Health Observatory
3.1.1 The main causes of ill-health death
The main causes of ill-health and death have changed in the last 150 years from
infections such as measles and TB, accidents and malnutrition, to diseases such as
heart attack, stroke and cancers. This shift from infectious and respiratory disease
deaths to circulatory (principally coronary heart disease and stroke) deaths is shown in
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green
Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
Woodhouse
Coppetts
Underhill
Oakley
Brunswick
Park
East
Barnet
High Barnet
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
81.5
82.6
83.1
78.9
82.5
75.6
83.8
77.7
82.7
77.8
81.4
76.5
76.0
78.8
82.1
76.7
83.1
79.4
78.2
83.3
83.3
79.7
81.5 77.3
79.0
84.3
81.0
77.6
82.0
76.0
85.2
82.7
81.0
78.7
84.7
81.4
81.4
75.7
79.7
82.9
79.3
83.4
Edgware
Hale
Burnt
Oak
Colindale
West
Hendon
Golders
Green
Childs
Hill
Hendon
Garden
Suburb
Finchley
Church
End
East
Finchley
Mill Hill
Totteridge
West
Finchley
West
Finchley
Woodhouse
Woodhouse
Coppetts
Underhill
Oakley
Brunswick
Park
East
Barnet
High Barnet
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
Index of Multiple
Deprivation (2007)
Very high
High
Moderate
Low
Very low
81.5
82.6
83.1
78.9
82.5
75.6
83.8
77.7
82.7
77.8
81.4
76.5
76.0
78.8
82.1
76.7
83.1
79.4
78.2
83.3
83.3
79.7
81.5 77.3
79.0
84.3
81.0
77.6
82.0
76.0
85.2
82.7
81.0
78.7
84.7
81.4
81.4
75.7
79.7
82.9
79.3
83.4

37
Figure 18: Age-standardised mortality rates for selected broad disease groups, 1911-2003,
England & Wales
Source: Office for National Statistics18
These changes principally come about because of the widespread availability of a clean
drinking water supply, the introduction of universal childhood immunisation, better
housing and better food. But this has led to diseases related to lifestyle becoming more
common. Many years ago, a doctor called Elliot Joslin said, “Genes load the gun, but it’s
lifestyle that pulls the trigger”. In other words, many of us may have a genetic
predisposition to certain diseases, but how we choose to live our lives will influence
whether we develop those diseases or not and, if we do, how severely they will affect us.
This is most apparent with smoking, which is the most important preventable risk factor
for death from cancer and cardiovascular disease.19,20
(It is also important to remember
that, in addition to the unequivocal evidence that smoking damages the smoker’s health,
there is also substantial evidence that exposure to second-hand tobacco smoke (e.g.
smoke from other people’s cigarettes) harms non-smokers.21,22,23,24,25
)
A further example of the way in which our own lifestyle can affect our health is
overweight and obesity. In 2004, a House of Commons select committee noted that ‘On
present trends, obesity will soon surpass smoking as the greatest cause of premature
loss of life. It will bring levels of sickness that will put enormous strains on the health
service, perhaps even making a publicly funded health service unsustainable.’26
Overweight and obesity increases the risk of developing diabetes and high blood
pressure (itself a risk factor for stroke). Overweight and obesity increases the risk of
developing arthritis, especially of the hip and knee. And obesity, a high fat diet and
inactivity have also been shown to increase the risk of breast cancer.27,28 Error! Reference source
not found.
shows the ‘relative risk’ (i.e. how much more (or less) something is likely to occur)
0
200
400
600
800
1911 1921 1931 1941 1951 1961 1971 1981 1991 2003
circulatory diseases
cancers
infections
respiratory disease
Age-standardised
deaths
per
100,000
0
200
400
600
800
1911 1921 1931 1941 1951 1961 1971 1981 1991 2003
cancers
infections
respiratory disease
0
200
400
600
800
1911 1921 1931 1941 1951 1961 1971 1981 1991 2003
0
200
400
600
800
1911 1921 1931 1941 1951 1961 1971 1981 1991 2003
cancers
infections
respiratory disease
Age-standardised
deaths
per
100,000

38
of developing different diseases in people who are obese. For example, Table 16 shows
that an obese woman is nearly 13 times as likely to develop diabetes as one who is not
obese, and an obese man is three times as likely to develop bowel cancer as one who is
not obese.
Table 16: Relative risks of health problems associated with obesity in women and men
Disease Relative risk (women) Relative risk (men)
Non-insulin
dependent diabetes
12.7 5.2
High blood pressure 4.2 2.8
Heart attack 3.2 1.5
Cancer of the bowel 2.7 3.0
Angina 1.8 1.8
Gallbladder disease 1.8 1.8
Cancer of the ovary 1.7 N/A
Osteoarthritis 1.4 1.9
Stroke 1.4 1.3
Source National Audit Office29
Another example of lifestyle issues affecting health is the misuse of alcohol. In addition
to alcoholic liver disease, alcohol misuse can cause a variety of health and other
problems. For example, driving under the influence of alcohol substantially increases the
risk of having an accident. Excessive alcohol intake is associated with antisocial
behaviour and street violence, as well as domestic violence. Alcohol is implicated in 78%
of assaults and 88% of criminal damage.30
Excessive alcohol intake also affects people’s
ability to work and, when it becomes a significant problem, this can often lead to job
loss.30
3.2 Immunisation
3.2.1 Overview
Immunisation is second only to a clean drinking water supply as a way of improving and
maintaining the health of the population. Whilst smallpox has been eradicated from the
world, by immunisation, all other infectious diseases remain; the only way to protect
children and adults from avoidable death and serious, often long-term, complications
from such diseases is to maintain high levels of immunisation in the population.iv
3.2.2 The risk we face
Barnet, in common with all other London boroughs, now faces the likelihood of a
measles epidemic. In the last year of so the number of children and adults catching
iv The main exception to this is TB. Whilst BCG vaccine is an important way to protect people most at risk
the way this disease affects the population has changed.

39
measles – the most contagious disease that there is – has been much higher than in
past years and there have been several outbreaks, as shown in Figure 19.
Figure 19: The number of reported cases of measles in Barnet in recent years
The reason that so many people have caught measles and the fact that we now face the
very real risk of a measles epidemic is because there are now so many children whose
parents have refused consent for them to be immunised with measles, mumps and
rubella vaccine. The ‘herd immunity’ of the population is now sufficiently low to enable
each person with measles to infect more than one other person. The problem of measles
is more widespread in other parts of London, as shown in Figure 20.
Figure 20: Notified cases of measles in London by sector and district between 1 January
and 5 July 2008 Source: Health Protection Agency. Measles and MMR uptake in London, 2008
0
10
20
30
40
50
60
70
80
90
2005/06 2006/07 2007/08
0
10
20
30
40
50
60
70
80
90
0
10
20
30
40
50
60
70
80
90
2005/06 2006/07 2007/08
2005/06 2006/07 2007/08

40
Figure 21 shows how MMR immunisation rates have dropped, more so in London than in
the rest of the country.
Figure 21: MMR uptake at age 2 years for London and UK – January 1996 – March 2008*
Source: Health Protection Agency. Measles and MMR uptake in London, 2008 Cover data and
trends in vaccine uptake 2005-2008
Figure 22: Immunisation rates in Barnet by children’s fifth birthdays
Figure 22 shows the current achievement in immunising children in Barnet for:
 first course of diphtheria, tetanus, pertussis and polio;
 first dose of Haemophilus influenzae B;
 meningococcus C;
 first dose of measles, mumps and rubella (MMR);
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
95.0
Q3 05/06 Q4 05/06 Q1 06/07 Q2 06/07 Q3 06/07 Q4 06/07 Q1 07/08 Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09
DTP/Polio primary
MMR 1st dose
Hib primary
MMR 2nd dose
MenC
DTaP/IPV booster
%
Quarter in each year
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
95.0
Q3 05/06 Q4 05/06 Q1 06/07 Q2 06/07 Q3 06/07 Q4 06/07 Q1 07/08 Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09
DTP/Polio primary
MMR 1st dose
Hib primary
MMR 2nd dose
MenC
DTaP/IPV booster
DTP/Polio primary
MMR 1st dose
Hib primary
MMR 2nd dose
MenC
DTaP/IPV booster
%
Quarter in each year

41
 second dose of MMR; and
 diphtheria, tetanus and pertussis and inactivated polio booster.
This shows clearly that MMR immunisation rates in Barnet are very substantially below
the level required for safety, i.e. to avoid measles outbreaks and to avoid a measles
epidemic, although they are beginning to increase.
3.2.3 The relationship between diversity and deprivation and infectious disease
Data on ethnicity and religious belief are not currently routinely recorded in the context of
childhood immunisation. However, it is apparent that in the North East and North central
London area, the majority of people affected by measles have been Jewish (see Figure
23). It is not clear why this should be and it is not apparent that this is the case in Barnet.
Figure 23: The number of reported cases of measles in North East and North Central
London in 2007/2008 by religious/ethnic group (Source: Health Protection Agency)
3.2.4 Local targets
In common with other London PCTs, Barnet has agreed to increase all of its childhood
immunisations to 90% by 2010/2011. Figure 24 shows the trajectory for MMR, which is
the most challenging as all other childhood immunisation rates are currently in the high
eighties and thus closer to the target.
0 50 100 150 200 250 300
Asian: Pakistani
Black: Other
Mixed: White & Asian
Mixed: White & Black African
Not known
Chinese
Asian: Other
Asian: Indian
Mixed: Other Mixed
Black: Caribbean
Asian: Bangladeshi
White: Other
Any Other ethnic group
White: Irish
Black: African
White: Eastern European
White: British
Jewish
Number of reported measles cases
0 50 100 150 200 250 300
Asian: Pakistani
Black: Other
Mixed: White & Asian
Mixed: White & Black African
Not known
Chinese
Asian: Other
Asian: Indian
Mixed: Other Mixed
Black: Caribbean
Asian: Bangladeshi
White: Other
Any Other ethnic group
White: Irish
Black: African
White: Eastern European
White: British
Jewish
Number of reported measles cases

42
Figure 24: The trajectory for immunisation rates for MMR by the age of two years
Source: Barnet PCT Operating Plan
3.2.5 Key things that need to be done
The key activities required are:
 ensuring the accuracy of immunisation records – it is apparent that a lot of children
have been immunised but the fact has not been recorded on the PCT’s child health
surveillance system;
 bolstering the immunisation call system to ensure that all children who need
immunisation (because it is due or have, apparently, been missed) are invited for
immunisation;
 providing immunisations in various sites, e.g. GP surgeries, community pharmacies,
A&E departments, walk-in centres, children’s centres, children’s outpatient
departments;
 promoting immunisation widely, using social marketing techniques, to better ensure
that the right message is received; and
 working with local community and religious leaders, and in schools, pre-school
facilities, children’s centres, NHS facilities and other places to promote immunisation.
73.9 74.5 75.6 76.4 77 80
90
2004_05 2005_06 2006_07 2007_08 2008_09 2009_10 2010_2011
0
10
20
30
40
50
60
70
80
90
100
Proportion
(%)
of
2-year
olds
with
first
MMR
immunisation
actual trajectory
estimate
73.9 74.5 75.6 76.4 77 80
90
2004_05 2005_06 2006_07 2007_08 2008_09 2009_10 2010_2011
0
10
20
30
40
50
60
70
80
90
100
Proportion
(%)
of
2-year
olds
with
first
MMR
immunisation
actual trajectory
estimate

43
3.3 Smoking cessation
3.3.1 Overview
Whilst immunisation is one of the most significant primary disease prevention activities,
smoking cessation is the most significant secondary preventive measure. It is best not to
start smoking, but it is never too late to stop: giving up – at any agev
– will lead to health
improvement and reduced risk of disease and premature death.
Figure 25 shows the estimated prevalence in different London boroughs. Even though
Barnet’s smoking prevalence overall is estimated to be only 17.9% and is one of the
lowest in London, (see also section 3.4.6), this still means that there are some 60,000
smokers in the borough.
Figure 25: The estimated prevalence of smoking in different parts of London
Source: Health Surveys for England 2003-200531
3.3.2 The risk we face
Tobacco use is the most important preventable risk factor for death from cancer and
cardiovascular disease.32,33
About 2,600 people die in Barnet each year. Of these, about
440 die from smoking-related diseases.34
This is more than from any other cause and
these deaths are all preventable.
Smoking tobacco causes diseases that affect nearly every part of the body. Smoking is
especially damaging to the lining of blood vessels and leads to a reduced blood supply
v About the only exception to this is that if someone is terminally ill, i.e. they are likely to die in the
next three months, then stopping smoking (always assuming that they are well enough to
smoke) will not lead to any significant health gain. In everyone else, it can be expected to do
so, if only by reducing the likelihood of a chest infection
0
5
10
15
20
25
30
35
B
arking
and
D
agenham
B
arnet
B
exley
B
rent Teaching
B
rom
ley
C
am
den
C
ity
and
H
ackney
Teaching
C
roydon
Ealing
Enfield
G
reenw
ich
Teaching
H
am
m
ersm
ith
and
Fulham
H
aringey
Teaching
H
arrow
H
avering
H
illingdon
H
ounslow
Islington
K
ensington
and
C
helsea
K
ingston
Lam
beth
Lew
isham
N
ew
ham
R
edbridge
R
ichm
ond
and
Tw
ickenham
Southw
ark
Sutton
and
M
erton
Tow
er H
am
lets
W
altham
Forest
W
andsw
orth
W
estm
inster
Estimated
smoking
prevalence
(%)

44
to various parts of the body. It is therefore a leading and avoidable cause of heart attack,
kidney failure, intermittent claudication and impotence. For the same reason, people who
are smokers when they have operations are more likely to suffer from wound breakdown
and to have delayed bone healing. Among many other conditions caused by smoking
are chronic obstructive pulmonary disease (COPD), coronary heart disease,
osteoporosis, insulin resistance in diabetes, infertility, age-related macular degeneration
(the most common cause of blindness in older people), premature menopause, Crohn’s
disease, gastro-oesophageal reflux and peptic ulcers, bone resorbtion and tooth loss,
multiple sclerosis, thyroid disease, hearing loss, and liver disease. Women who smoke
when pregnant damage the placenta and this leads to a reduced blood supply to their
baby. Smoking is also a cause of premature hair loss and premature skin ageing (so
children are right: smoking does make you look older).
In addition to the unequivocal evidence that smoking damages the smoker’s health,
there is now substantial evidence that passive exposure to tobacco smoke harms non-
smokers.35,36,37,38,39
Second-hand smoke causes lung cancer, coronary heart disease,
stroke, asthma attacks, reduced growth of babies in the womb and premature birth, and
in children it causes cot death, middle ear diseases, respiratory infections, the
development of asthma in those previously unaffected and asthma attacks in those
already affected.40
3.3.3 The relationship between diversity and deprivation and smoking-related disease
There are differences in smoking habits between the sexes and between people in
different ethnic groups. This is shown in Figure 26. Principally, this is important when
planning smoking cessation services. It is important that promotion and provision of such
services are culturally appropriate and that smokers see them as relevant to them and
not just to others.
Figure 26: Current cigarette smoking by ethnic group and sex in England in 1999
Source: Office for National Statistics41
General population
White Irish
Indian
Pakistani
Bangladeshi
Black Caribbean
Chinese
0 10 20 30 40 50
Proportion of smokers in different ethnic groups (%)
Men
Women
General population
White Irish
Indian
Pakistani
Bangladeshi
Black Caribbean
Chinese
0 10 20 30 40 50
General population
White Irish
Indian
Pakistani
Bangladeshi
Black Caribbean
Chinese
0 10 20 30 40 50
Men
Women

45
Smoking is more prevalent amongst people who live in deprived areas. Figure 27 shows
the differences in smoking habits between people from different social classes; people in
routine and manual occupations (and those who are unemployed) are more likely to live
in deprived areas than those in managerial and professional occupations.
Figure 27: Cigarette smoking by sex and socio-economic classification, adults aged 16
and over, 2006, Great Britain
Source: British Heart Foundation42
As smoking is the cause of so many deaths, and it is more common amongst people
living in more deprived areas, an important cause of the differences in death rates
between affluent and deprived areas is likely to be smoking. Seeking to increase the
proportion and the absolute number of smoking quitters in deprived areas will thus
contribute to reducing health inequalities.
Finally, deaths from COPD – principally a disease caused by smoking – in Barnet are
now higher amongst women than men, and deaths from lung cancer in women will soon
become more common than deaths from breast cancer. This is simply because an
increasing number of women took up smoking in the 1940s and 1950s: they are now
reaping the longer-term consequences of this.
3.3.4 Local targets
Figure 28 shows how the number of people quitting smoking through NHS services has
increased over the last few years. In 2005/06, Barnet PCT exceeded its target for
smoking quitters for the first time and did so again last year. Currently, the PCT is ahead
of our quarterly target and should exceed the target for 2008/09.
The PCT also has a ‘stretch target’ to enable a higher proportion of smokers in the seven
most deprived electoral wards in Barnet to quit smoking. This target was achieved last
year and, again, the PCT is ahead of its quarterly target and should exceed the annual
one.
0
5
10
15
20
25
30
35
Managerial & Professional Intermediate Routine & Manual
Men
Women
0
5
10
15
20
25
30
35
Managerial & Professional Intermediate Routine & Manual
Men
Women

46
Figure 28: The number of people quitting smoking through NHS services in Barnet
Source: Barnet PCT Stop Smoking Service data returns to Department of Health
3.3.5 Key things that need to be done
The key activities required are:
 maintaining current performance on smoking cessation;
 identifying greater numbers of quitters in more deprived areas and enabling them to
quit (see also section 3.4.6);
 introducing techniques, such as measuring ‘lung age’ to increase quit rates; and
 raising awareness amongst health and social care personnel and the public of the
risks of being a smoker when a surgical procedure is required to encourage and
facilitate more smokers to quit.
3.4 Coronary heart disease and stroke: preventing vascular disease
3.4.1 Overview
Coronary heart disease (CHD) is caused by the progressive narrowing or by the
blockage of one or more of the small arteries that supply the muscle of the heart. As less
blood gets through these arteries the oxygen supply to the heart muscle is reduced. This
causes pain on exertion (angina) and reduces the amount of work that the heart can do.
If the narrowing gets too great or there is a sudden blockage caused by a small blood
clot the blood supply to a portion of the heart is stopped completely. This is a ‘heart
attack’ and, together with stroke, is still the most common cause of death in this country
and in Barnet. For example, since 1993, the average number of deaths in Barnet, from
all causes, has been 2,840 (it has dropped steadily from 3,130 in 1993 to 2,461 in 2006).
The average number of deaths in Barnet each year from heart attack over this time has
been 280 (it has dropped steadily from 326 in 1993 to 202 in 2006).
Figure 29 shows comparative rates and trends in deaths from heart attack in England
and Wales, London and Barnet. Rates are decreasing, but they are lower in Barnet and
decreasing at a slightly higher rate. In part, this is due to a lower average prevalence of
smoking in the borough and an above-average level of affluence.
0
500
1000
1500
2000
2500
3000
3500
2002/03 2003/04 2004/05 2005/06 2007/08
Number
of
smoking
quitters
0
500
1000
1500
2000
2500
3000
3500
2002/03 2003/04 2004/05 2005/06 2007/08
Number
of
smoking
quitters

47
Figure 29: Age-standardised death rate from heart attack nationally, in London and Barnet
Stroke is caused by either a blockage of one of the blood vessels supplying the brain or,
less commonly, by one of these blood vessels bursting and bleeding. In either event, the
blood supply to a portion of the brain is suddenly stopped. This is a ‘stroke’ (also called a
cerebro-vascular accident or ‘CVA’) and leads to a permanent loss of function of the part
of the brain affected.
Figure 30 shows comparative rates and trends in deaths from stroke in England and
Wales, London and Barnet. Like heart attack, rates are decreasing, but they are lower in
Barnet and decreasing at a slightly higher rate.
Figure 30: Age-standardised death rate from stroke nationally, in L Like heart attack,
London and Barnet
These two diseases have similar origins: they are usually caused by progressive
damage to the lining of blood vessels. This damage occurs in many parts of the body but
the heart and the brain are more susceptible to a loss of blood supply than most other
organs. CHD and stroke are often combined into one condition – cardio-vascular disease
(CVD) for this reason.
The most common causes of CVD are smoking, high blood pressure, raised blood
cholesterol levels and diabetes. These last three risk factors are much more common
amongst people who are obese. Put another way, the most common cause of death in
30
50
70
90
110
130
150
170
190
210
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Age-standardised
death
rate
per
100,000
England and Wales London Barnet
30
50
70
90
110
130
150
170
190
210
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Age-standardised
death
rate
per
100,000
30
40
50
60
70
80
90
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Age-standardised
death
rate
per
100,000
30
40
50
60
70
80
90
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Age-standardised
death
rate
per
100,000

WCC Submission 30.11.08

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