2. Purpose Summary of areas of focus Update on the latest intelligence and analysis arising from Warwickshire’s JSNA Key messages to better inform stakeholders to make evidence led decisions Warwickshire as a place Stakeholder views Next steps and future work

3. What is the JSNA? Joint Strategic Needs Assessment Framework for partnership involving all stakeholders in identifying and acting on need Strategic direction for commissioning of services Identify health & wellbeing inequalities, assets and gaps from existing information Include outputs that can be translated into action & recommendations to be taken forward

4. JSNA Priority Topics Current and future health & wellbeing needs of the local population - key local priorities across health & social care

5. Warwickshire as a Place Context: Demographic Change – growing and ageing 623,900 people by 2037, up 13% from 2014. Age 85+ up 165% by 2037. Housing composition – shift in how people choose to live. Older people will live independently for longer, young adults will live with their parents for longer and rising proportions of single person and transient households. Economic Climate - whilst the outlook for Warwickshire’s workforce and economy appears strong; this should be set against the backdrop of the Government’s welfare reform programme, uneven economic recovery and uncertain growth in Europe. Our services WILL need to adapt

6. A growing Warwickshire

7. Warwickshire as a Place Social Care in the future? – preventative approaches (Care Act) – personalisation including Personal Budgets & Direct Payments – integration of care services across health & social care including integrated commissioning of services – Dilnott Report recommendations – changing inspection guidance – quality assurance Technology – Self-serve but also recognising needs of most vulnerable - more intensive users of our services least willing or able to interact with us in the most cost efficient ways? Our services WILL need to adapt

8. Inequalities - 2015 deprivation IMD 2015 Warwickshire is ranked 124 th out of 152 LAs 8 areas in top 10% in 2015 : 6 in Nuneaton & Bedworth 1 in Warwick 1 in North Warwickshire Lower Super Output AreaDistrict/Borough IMD 2010 Rank IMD 2015 Rank Warwickshire rank (2015) Bar Pool North & CrescentsNuneaton & Bedworth4924661 Camp Hill Village & West*Nuneaton & Bedworthn/a1,4852 Kingswood Grove Farm & RuralNuneaton & Bedworth1,3351,6363 Abbey Town CentreNuneaton & Bedworth1,4782,2534 Middlemarch & Swimming PoolNuneaton & Bedworth1,6892,2575 Lillington EastWarwick4,3582,8416 Hill TopNuneaton & Bedworth2,6723,1227 Mancetter South & Ridge LaneNorth Warwickshire6,2943,2258 Bede EastNuneaton & Bedworth3,5393,9669 Abbey PrioryNuneaton & Bedworth2,6484,25610 Camp Hill East & Quarry*Nuneaton & Bedworthn/a4,36011 Abbey NorthNuneaton & Bedworth8,1274,37012 RiversleyNuneaton & Bedworth4,0314,96313 Bede CannonsNuneaton & Bedworth6,0355,00014 Poplar Coalpit FieldNuneaton & Bedworth5,7875,09215 Atherstone Central-CentreNorth Warwickshire4,8665,44516 Brownsover South Lake District NorthRugby3,3145,62717 Kingswood Stockingford SchoolsNuneaton & Bedworth7,0985,76418 Growing and more dispersed inequality across Warwickshire

9. Health: Projecting numbers of residents with limited activity

10. JSNA Stakeholder Engagement A lot of positive progress – National case study – Clear evidence that JSNA has been used to set priorities across Warwickshire’s 3 CCGs – Clarity on what JSNA stands for and its importance – Positive feedback for the scoring/prioritisation system used to decide on priorities – And more……… ….but still work to do to ensure an evidence-cased culture! – Further work to understand role of evidence in our planning – including improving culture – When evidence is used, it’s not often thought of as coming from the JSNA – umbrella for evidence – Reinforce the link to all stakeholders between JSNA and better commissioning of services – Broader determinants of health are reflected in JSNA more consistently Keep the process simple and inclusive – Co-design project briefs – Output driven Communicate, communicate, communicate! – Collective responsibility of all including Health & wellbeing Board members

11. JSNA Stakeholder Engagement Closer relationships & better synchronise commissioning activity – Working better together consistently across ALL partners – Recognise and promote the role of the commissioner in the needs assessments BANG! The JSNA needs to have more impact but requires better data! – ‘Used strategically and ad-hoc as opposed to an embedded process’ – The JSNA should be a means of helping remove constraints to sharing data – More qualitative evidence used including engagement with customers – Evaluation of needs assessments should be routine to ensure recommendations are taken forward – Mixed messages on what’s needed: ‘Doesn’t drill down far enough’ vs ‘don’t need that level of detail’ – More focus in needs assessments on early intervention in relation to health & wellbeing board issues Quicker, faster, more responsive but what resource do we have? – Increase pace and turnaround of material to ensure it maintains relevance and usability. – Greater clarity on resource in the JSNA ‘team’ and permanency of this resource? The points raised in the interviews will be developed and taken forward by the JSNA Commissioning Group

12. Looked After Children Children aged between 10 and 15 years represent the majority of the looked after population in Warwickshire (39%), while children under one year old are in the minority (6% of the looked after population). Warwickshire’s looked after population includes slightly more boys than girls (54% compared with 46%). These age and gender related distributions have remained relatively constant over the past five years and are comparable to the national picture. The number of looked after children in Warwickshire has increased by 8.5% over the past five years from 636 children at 31 March 2011 to 690 at 31 March 2015. Warwickshire’s rate of looked after children is 62 per 10,000 children under 18 years, higher than the England average (60) and considerably higher than Warwickshire’s statistical neighbours (49) at 31st March 2014.

13. Educational Attainment of Disadvantaged Pupils

14. Vulnerable Children There is no single approach to defining vulnerability in children. In Warwickshire, there were 15,315 children considered to be living in poverty in 2011. This equates to 14% of all children and is considerably below the national and regional equivalent figures of 20% and 23% respectively. Helping Vulnerable Children Needs Assessment due to be published soon.

15. Mental Health Inequalities in life expectancy for those with severe mental illness - 15 and 25 years shorter. The excess under 75 mortality rate for adults with a serious mental health illness in Warwickshire in 2012/13 was 366 compared with 347 nationally. Higher suicide rate (9.3 per 100,000 population) in Warwickshire and in males, 15.7 per 100,000 compared with 3.3 for females. In 2012/13, the rate of hospital admissions as a result of self- harm in young people in Warwickshire was 421 per 100,000 population aged 10-24 years - significantly higher than the England (346 per 100,000 population) and the West Midlands (366 per 100,000 population) averages.

16. Dementia Diagnosis rates for dementia have been historically low, meaning many people have not received appropriate treatment to manage their condition. There are 4,143 registered patients diagnosed with dementia in Warwickshire. However, there are an estimated 7,634 individuals in Warwickshire with dementia, both diagnosed and undiagnosed. Just over half of those with dementia have a diagnosis (54%) in Warwickshire.

17. Cancer It is estimated that one in two people born after 1960 in the UK will be diagnosed with some form of cancer during their lifetime. By 2020, there will be nearly two million people aged 65 and over with a cancer diagnosis. In Warwickshire, there are approximately 2,500 new cases of cancer diagnosed each year. There are around 1,400 deaths from cancer each year across the county, representing 28% of all deaths. In the last 5 years, almost 600,000 cancer cases in the UK could have been prevented. Four in ten (42%) cases be prevented by lifestyle changes (such as not smoking, keeping a healthy body weight, reducing alcohol consumption, eating a healthy balanced diet). NHS - £5 BILLION Society - £18.3 BILLION

18. CardioVascular Disease Family of diseases (including stroke, heart attack and peripheral vascular disease) which share a common set of risk factors. Over 12% (53,100) of the population aged 16 and over in Warwickshire are estimated to be living with CVD: – 6% (24,600) estimated to be living with Coronary Heart Disease (CHD) – 2.6% (11,300) with Stroke. In Warwickshire in 2013/14, there are over 27,000 patients on GP registers for stroke and CVD which suggests a notable gap between the estimated and observed prevalence. There are also over 83,000 patients with hypertension (high blood pressure – common risk factor for CVD) - nearly 15% of population. CVD is the second most common cause (after cancer) of death in Warwickshire accounting for approximately 1,400 deaths (27%) a year. However, there continues to be an overall decline in the number and rate of deaths from CVD across Warwickshire.

19. Weight Management Estimates suggest 22% of adults in Warwickshire are classed as obese - 98,600 adults. A further 43% of adults are estimated to be overweight So, 2 out of 3 adults are carrying excess weight in Warwickshire. Evidence suggests a strong link between obesity levels and deprivation: there is a higher prevalence of obesity in young children from deprived households than affluent households. In Warwickshire, there is a clear geographical trend in the proportion of year six children who are either overweight or obese, ranging from 37% in North Warwickshire Borough to 29% in Warwick District.

20. Smoking/Smoking in Pregnancy The prevalence of smoking among persons aged 18 years and over in Warwickshire, in 2013, was 14.5%. In 2014/15, 11.5% of mothers in Warwickshire were estimated to be smoking at time of delivery. This equates to around 700 babies born in Warwickshire who have effectively already been smoking for nine months. Smoking is the principle cause of preventable premature death - killing more people than the combined total of the six next largest causes put together – a total of around 100,000 deaths in the UK each year. The proportion of adult smokers in Warwickshire has fallen from 20% in 2010 to 15% in 2013; the second lowest among upper tier local authorities in the region.

21. Substance Misuse & Alcohol 35% of Warwickshire adults, equating to over 153,000 people, are estimated to be drinking at increasing and higher risk drinking levels. It is difficult to obtain local estimates of the number of people who use drugs in Warwickshire, however nationally, one in 11 adults aged 16 to 59 had taken an illicit drug in the last year, equating to over 28,000 people in Warwickshire. The rate of alcohol related admissions in 2013/14 is 303 people per 100,000 in Warwickshire, equating to roughly 1,650 people. In Warwickshire, the rate of alcohol related admissions between 2011/12 and 2013/14 for young people under 18 years was 42.6 per 100,000 people - higher than national rate (40.1).

22. Carers Carers Needs Assessment due to be published soon

23. Delivering Year 1 priority Needs Assessments including: – Carers – Helping Vulnerable Children – Looked After Children Ongoing needs assessments Other Needs Assessment activity Foundation workstreams including: – Data Sharing – Alignment of commissioning cycles – Communications Action plan from stakeholder engagement Future work programme and next steps

24. More information http://hwb.warwickshire.gov.uk/