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A key element of NHS and public sector planning is an understanding of the size of the population, weighted for age and level of health need, the demography of the population being served and how that might be changing in the early part of the 21st century. Local NHS board funding is largely based on a weighted capitation formula which is designed to be sensitive to population change and direct funding in line with population growth and decline.

Lothian and Scotland

Lothian’s population differs markedly from the Scottish average in terms of the proportion of younger people resident within its boundaries. This reflects the large student population within the city of Edinburgh and young professionals working in the services sector. This younger bias also impacts on the older age groups, making them appear under represented compared to the overall makeup of the Scottish population (Figure 1).

Figure 1: Proportion of population by age: Lothian vs Scotland

Figure 1: Proportion of population by age: Lothian vs Scotland

The official source for all census and population statistics used in public sector planning is the General Registrar for Scotland’s office, GRO(S), which produces Health Board and Local Authority specific population estimates and projections. It is the latest version of these publications that is cited here (2006 based population projections published January 2008(1)).

Over the last 10 years Lothian has seen the highest population growth of any Scottish Health Board (+ 5.3% – see Figure 2) and the most recent population projections at Health Board level (GRO (S) 2006-based) suggest this growth will continue and increase over the coming 10 years (+ 7.2% – see Figure 2). Indeed, East Central Scotland in general will see significant population growth in Borders, Fife, Forth Valley and Tayside as will the Northern areas of Scotland (Grampian & Highland). In contrast, the West Coast and the more rural and remote areas of Scotland will see some population decline over the next decade.

Figure 2: Population change by Health Boards

Figure 2: Population change by Health Boards

Between 2007 and 2017 the population of Lothian is projected to increase by some 58,000 people. The majority of this increase will take place in the City of Edinburgh (+ 36,174) and West Lothian (+ 15,288). East Lothian is projected to grow by some 7,398 residents whilst the population of Midlothian is projected to decline by 795 people overall over the next 10 years.

Age Structure

The changing age structure of a population is an important indicator of potential future NHS demand. Examining the Lothian projected year on year population growth by age group (Figure 3) reveals the dramatic increase in the 65-74 years age group in 2012, which reflects the changing balance of population from 2011 onwards as the post-war baby boom moves through to older age. In addition, more people will live beyond 85 years in Lothian at 2017.

Figure 3: Year on year population growth by age group

Figure 3: Year on year population growth by age group

The projected population growth in Lothian can be seen at local authority level over the coming 10 years (Figure 4). The single largest component of this growth is in the under 65 years age group in the City of Edinburgh. West Lothian and East Lothian also experience significant growth in the under 65 years population over the coming decade – but Midlothian sees a significant reduction in its younger age group. In total, the Lothian under 65 years population is projected to grow by almost 33,000 people in the coming 10 years. All council areas will see growth in their older age groups (65 years+) during this period, amounting to 25,000 people. This will have an impact on local and Lothian-wide NHS services given the preventable nature of many more conditions and the increasing use of the service by 45-75 year olds.

Figure 4: Projected population change 2007-2017

Figure 4: Projected population change 2007-2017

Lothian’s Ageing Population

The growth in Lothian’s older citizens (65 years+) is different in each local authority area with improved male survival an important feature.

City of Edinburgh

In the City of Edinburgh there is a marked rise in the number of both males and females in the 65-74 years age group from 2012 – but in the older age group (75 years+) there is a steady growth in the numbers of men compared with little change in the numbers of older women.

City of Edinburgh

West Lothian

In West Lothian the growth in both men and women in the 65-74 years age group is comparable as is the numbers of men and women in the older (75 years+) age grouping.

West Lothian

East Lothian

East Lothian also sees similar growth rates for both men and women in the 65-74 years age group, though greater male survival in the older (75 years +) age group is evident.

Eest Lothian

Midlothian

Whilst Midlothian is the only area of Lothian with a projected net population reduction of people under the age of 65 years it sees significant growth in its older population in both age ranges.

Midlothian

Vital Indicators for the Lothian Population

Population projections are made up of two key components: ‘natural change’ is the net effect of births minus deaths, which together with net migration (inflows minus outflows) results in the future population estimates. (Figure 5) above shows the key population rates for births and deaths for Lothian local authorities. West Lothian, East Lothian and Midlothian have above average birth rates but East Lothian has an adult death rate slightly above the Scottish average.

Figure 5a: Live birth rate and adult death rate

Figure 5a: Live birth rate and adult death rate

Figure 5b: Perinatal, neonatal and infant deaths

Figure 5b: Perinatal, neonatal and infant deaths

(Figure 6) provides a range of demographic characteristics for the Lothian local authority areas, illustrating the significant inward migration to the City of Edinburgh and the high proportion of males in managerial jobs and relatively low proportion of people with no educational qualifications. Unemployment is also lower than the national average in the Lothians. These demographic characteristics are associated with better health status.

Figure 6: Population trends in the Lothians

Figure 6: Population trends in the Lothians

The final comparison in (Figure 7) shows the primary causes of death in Lothian and across Scotland. There are three causes of death in Lothian that are above the national average – neoplasms (cancers), mental health related deaths and infections. On all other causes of death Lothian is below or on the national average.

Figure 7: Causes of death Q3 2007

Figure 7: Causes of death Q3 2007


Key points

  • Lothian’s population is projected to grow at an unprecedented rate over the next decade. The majority of this growth relates to the under 65 years age grouping in the City of Edinburgh – though West Lothian will also see significant growth in its younger population with the majority of this growth related to inward migration.
  • There will be an expansion in the numbers of older people in Lothian (65 years+) and improved male survival is an important component of this projected growth.
  • The expansion of Lothian’s resident population will have a tangible impact on the demand for, and sustainability of, NHS services – particularly primary care and community health services. However, the acute hospital sector will also need to respond to the growing numbers of older people, many of whom will live longer and present more complex care needs.