Key Emerging Themes Health & Wellbeing Board 10th November 2011 Dr John Linnane Claire Saul

Content The Story So Far… Theme Summaries – Content Selection Criteria Key Emerging Themes What Next?

Purpose of the JSNA To identify current & future health & wellbeing needs To establish a shared, evidence based consensus on key local priorities To form a key element in the Commissioning Cycle

The Story So Far…. Just the starting point! Full annual review of existing work Produced series of key message summaries More detailed needs assessment work required Ongoing programme of work Analysis of health, social care, demographic, socio-economic, housing data But…more than just ‘facts & figures’- complete evidence base Will include broader range of qualitative information Knowledge, pathway information, consultation activity with stakeholders, service users, professionals, etc. Purpose of the summaries – to provide a focus for JSNA and HWB Strategy

Theme Summaries - Content 1 page summary Headline data analysis Findings from consultation activity Links to outcomes sought Links to related strategies / further info ‘Who Needs to Know This’ Reviewing current demand/performance/issues

Theme Summaries - Content Not just a look back! Part of a wider evolving process Series of web-based tools JSNA as a vehicle To move forward/model future need To inform service commissioning strategies Series of web-based tools – Website / Local Information System (LIS)

Selection Criteria Identification of themes in terms of: Resource gap Demand Volume Significant inequalities By geography and/or population group

Warwickshire JSNA Theme Summaries - 2011 Children Educational Attainment Looked After Children Lifestyle & Reducing Inequalities Vulnerable Communities Disability Safeguarding Long-Term Conditions Mental Wellbeing Ageing Dementia Ageing & Frailty Children/Young People General Population Older People

1. Children - Educational Attainment Current issue/challenge/trend Although Warwickshire above the national average – big geographic & population group variation Importance of education as the key socio-determinant of health & wellbeing. What is the gap? 63% of children not on FSM achieve 5 A*-C including English & Maths compared with 30% of children on FSM. What are we doing about it? Raise awareness in schools and support identified schools. Promote uptake of FSM to secure funding to tackle impact of social deprivation on attainment Numbers increased by 32% over last 3 years; from 482 in 07/08 to 636 in 10/11. In 2009/10, only 4% LAC achieved 5+ GCSEs (Grades A*-C including Maths & English) compared with 59% of all children in Warwickshire. 47% 5+ GCSEs (Grades A*-C including Maths & English) in North Warks v 68% in Stratford-on-Avon. 33 percentage point difference between those eligible for free school meals and those who are not, in achieving 5+ GCSEs (Grades A*-C including Maths & English).

1. Children - Looked After Children Current issue/challenge/trend Numbers increased by one third over last three years. Huge inequality in attainment levels between LAC & all other children. Poor health outcomes Over-representation in the justice system What is the gap? Educational attainment & health outcomes to match those of other children Sufficiency test Housing needs What are we doing about it? Dartington Project Early intervention Capital support to foster homes Numbers increased by 32% over last 3 years; from 482 in 07/08 to 636 in 10/11. In 2009/10, only 4% LAC achieved 5+ GCSEs (Grades A*-C including Maths & English) compared with 59% of all children in Warwickshire. 47% 5+ GCSEs (Grades A*-C including Maths & English) in North Warks v 68% in Stratford-on-Avon. 33 percentage point difference between those eligible for free school meals and those who are not, in achieving 5+ GCSEs (Grades A*-C including Maths & English).

2. Lifestyle & Reducing Inequalities Current issue/challenge/trend Levels of obesity, alcohol related hospital admissions, STIs, all rising. Smoking, whilst decreasing, still a key public health issue. Massive impact on demand for and cost of health & social care services. Housing 1 in 4 adults (110,000 people) in Warwickshire is estimated to be obese. 20% of Reception age and over 31% Yr 6 children classed as being overweight and obese. The rate of alcohol-related hospital admissions has more than doubled since 2002/03 and continues to rise. 130,000 people in Warwickshire still smoke. In 2010/11, in Warwickshire, nearly 1,000 babies were born to women who were smoking at the time of delivery. Total numbers of STIs in Warwickshire has risen by more than 20% since 2003. All of the top 13 most deprived SOAs from the Index of Multiple Deprivation (IMD) 2007 have shown considerable deterioration in the IMD 2010 rankings, suggesting that the gap between the most and least deprived areas of the County is widening. There is considerable variation in life expectancy at birth across the County ranging from 75 in Abbey ward, Nuneaton to 88 in Leek Wootton, Warwick

2. Lifestyle & Reducing Inequalities Current issue/challenge/trend Latest data shows that the gap between the most & least deprived areas of the County is widening. 13 years variation in life expectancy at birth across the County. The health of our most disadvantaged in society should be our top priority (Marmot). 1 in 4 adults (110,000 people) in Warwickshire is estimated to be obese. 20% of Reception age and over 31% Yr 6 children classed as being overweight and obese. The rate of alcohol-related hospital admissions has more than doubled since 2002/03 and continues to rise. 130,000 people in Warwickshire still smoke. In 2010/11, in Warwickshire, nearly 1,000 babies were born to women who were smoking at the time of delivery. Total numbers of STIs in Warwickshire has risen by more than 20% since 2003. All of the top 13 most deprived SOAs from the Index of Multiple Deprivation (IMD) 2007 have shown considerable deterioration in the IMD 2010 rankings, suggesting that the gap between the most and least deprived areas of the County is widening. There is considerable variation in life expectancy at birth across the County ranging from 75 in Abbey ward, Nuneaton to 88 in Leek Wootton, Warwick Child Poverty Strategy

3. Vulnerable Communities - Disability Current issue/challenge/trend Although prevalence rates are lower in Warwickshire than nationally, there are still significant numbers of people with a physical or learning disability. The complexity of future care provision for disabled people will grow & personalisation will offer much greater choice. 33% of adults with learning disabilities live in institutional care. What is the gap? In Warwickshire, 33% of people with LD live in institutional care. Best in practice nationally has single figures. Six lives audit sets the standards What are we doing about it? The market will need developing for personalisation. Development of supported living There are estimated to be 80,000 disabled people living in Warwickshire, 19% of the over 16 population.  All Warwickshire’s Districts and Boroughs have lower proportions of their adult populations who are disabled than the equivalent National and Regional figures.  In the County, North Warwickshire has the largest proportion of its adult population estimated to be disabled at just below 22%. Prevalence rates indicate that there are 9,310 people aged 14 and over who have some form of learning disability, this is projected to increase to 9,570 by 2015. 14,756 pupils are defined as having a special educational need (SEN) - 19.7% of the school population. LTCs or chronic conditions are those which can be controlled but not cured at present. Health problems or disability which limits daily activities incl problems due to old age.

3. Vulnerable Communities - Safeguarding Current issue/challenge/trend 20% increase in number of adult referrals 14-16% increase in number of children’s referrals Partial commitment from partners What is the gap? Safeguarding is everyone’s business What are we doing about it? Strong children’s safeguarding board Strengthening adult’s safeguarding board New strategy & process this financial year

4. Long-Term Conditions Current issue/challenge/trend An estimated 1 in 3 people in Warwickshire live with one or more long term conditions. In the over 75s, this rises to 2 in 3 people. WHO – leading cause of morbidity by 2020. ‘Invisible Epidemic’ Variation in QoF delivery across County Acute hospital admission rates are lower with better QoF management There are estimated to be 80,000 disabled people living in Warwickshire, 19% of the over 16 population.  All Warwickshire’s Districts and Boroughs have lower proportions of their adult populations who are disabled than the equivalent National and Regional figures.  In the County, North Warwickshire has the largest proportion of its adult population estimated to be disabled at just below 22%. Prevalence rates indicate that there are 9,310 people aged 14 and over who have some form of learning disability, this is projected to increase to 9,570 by 2015. 14,756 pupils are defined as having a special educational need (SEN) - 19.7% of the school population. LTCs or chronic conditions are those which can be controlled but not cured at present. Health problems or disability which limits daily activities incl problems due to old age. What are we doing about it? Community equipment Telecare Telehealth

5. Mental Wellbeing Current issue/challenge/trend Statistics are likely to underestimate the scale of both adults & children in Warwickshire with a mental illness. 53,221 (10.2%) people in Warwickshire provide unpaid care for a relative, friend or neighbour. ‘No Health without Mental Health’ Schools feel unsupported with mental health & behaviour problems. ‘Programme Budgeting’ analysis indicates high levels of comparative spend without outcome benefit Mental wellbeing - John is doing this one but Wendy had some suggestions too: Gap - Schools feel unsupported with mental health and behaviour problems.         - Significant differences identified between North and South 3rd section - New contract in CAMHS         - school to school support        - mental health strategy refresh ongoing

6. Ageing - Dementia Current issue/challenge/trend It is estimated that the number of older people with dementia in Warwickshire will double in next 20 years, to more than 13,000. Are services ready to cope with this future demand? Early diagnosis Lifestyle opportunities By 2030, it is estimated that more than 37,000 people over 65 in Warwickshire will be obese with greater risks for diabetes, heart disease and other associated health problems. An estimated two thirds of over 75 year olds in Warwickshire live with one or more long term conditions, many of which are not known to the older person’s general practitioner. In the next 20 years, new cancer cases are expected to increase by 70% in males over 70% and 50% in females. Dementia is expected to increase by almost 90% in people aged over 60. Frail older people stay in hospital longer, occupy two thirds of hospital beds and are the main users of long term care services, much of which is unnecessary. 22% of all non-planned emergency inpatient admissions are to people aged over 75. The proportion of spend for hospital activity on the over 75 year old population is 26% of all activity and 39% of non-elective costs In 2010/11 8,920 people received a funded social care service from Warwickshire County Council, 2,180 of these were in permanent residential or nursing care What are we doing about it? Designing services such as extracare & telecare that support people to continue to live at home. Communities taking care of themselves

6. Ageing - Ageing & Frailty Current issue/challenge/trend Consequences of a rapidly ageing population - Increases in numbers with limiting long-term conditions, cases of cancer, emergency hospital admissions, dementia, etc. Additional pressures placed upon our services (particularly health & social care). Issue of quality of life experienced by our residents as their life expectancy increases. By 2030, it is estimated that more than 37,000 people over 65 in Warwickshire will be obese with greater risks for diabetes, heart disease and other associated health problems. An estimated two thirds of over 75 year olds in Warwickshire live with one or more long term conditions, many of which are not known to the older person’s general practitioner. In the next 20 years, new cancer cases are expected to increase by 70% in males over 70% and 50% in females. Dementia is expected to increase by almost 90% in people aged over 60. Frail older people stay in hospital longer, occupy two thirds of hospital beds and are the main users of long term care services, much of which is unnecessary. 22% of all non-planned emergency inpatient admissions are to people aged over 75. The proportion of spend for hospital activity on the over 75 year old population is 26% of all activity and 39% of non-elective costs In 2010/11 8,920 people received a funded social care service from Warwickshire County Council, 2,180 of these were in permanent residential or nursing care Gap – Keeping people in their own homes What are we doing about it? - Cutting the cost of frailty programme, e.g. decide to admit, discharge to assess

What next? Emerging issues & themes will fundamentally underpin HWB Strategy JSNA Stakeholder Conference – early 2012 Continued consultation & engagement Delivery of more comprehensive Needs Assessment Programme Embedding more consistent approaches to producing needs assessments Transparency of information/content JSNA Website/Local Information System (LIS)