JSNA Needs Assessments (thematic)

All thematic JSNA needs assessments will be available on this page as they are completed and approved as well as wider needs assessment activity relevant to stakeholders working across health and social care in Warwickshire.

To view our current programme of work related to place-based needs assessments, please click on the following link to be taken directly to the page:

JSNA Place-based Needs Assessments

 School Health and Wellbeing Service Needs Assessment (2018)

This needs assessment looking at the health and well-being needs of school-aged children (5-19 years old) was updated in November 2018. It outlines relevant national policies and programmes and provides a Warwickshire context for those commissioning and providing services for school-aged children in the county. It also includes a review of the School Health & Wellbeing Service.

In 2018, there were 238 State funded schools in Warwickshire: 35 secondary schools, 192 primary schools and 11 special schools, with just over 82,000 children and young people attending these schools. Of these children , 13.1% had Special Educational Needs and 9.6% spoke a language other than English as their first language. The needs assessment highlights variation within Warwickshire with regards to demographics, educational attainment, health related behaviour and health outcomes. It also provides an overview of those children and young people who are classed as vulnerable and may have different health and wellbeing needs.

The role of the School Health & Wellbeing Service is essential. The service is in an ideal position to support children and young people in achieving positive health and wellbeing outcomes and to work in partnership with schools, parents/carers and other key professionals. Based on the information provided within this report and the range of detailed evaluations and consultation on the current service key recommendations are identified for future service commissioning.

The updated report is available to download below:

Needs Assessment of School Aged Children in Warwickshire and School Health & Wellbeing Service Review (2018 update) (PDF, 2.9MB)

 Injuries Leading to a Hospital Admission in 0-14 Year olds in Warwickshire – A review of hospital episode statistic data (2018)

This initial report examines the rise in hospital admissions following an injury in Warwickshire by providing an overview of admissions for childhood injuries in Warwickshire, and where available providing comparative rates between Warwickshire, our statistical peers, the West Midlands region and England. It includes comparative rates within the districts and boroughs in Warwickshire. The most common types of injury sustained are described.

The report also examines the pathways from injury to hospital admission. Accident and Emergency (A&E) departments are the main route to an admission in hospital following an injury. For this reason Hospital Episode Statistics (HES) data for A&E attendance following an injury is also examined, along with the characteristics of those attending A&E and those who are then admitted to hospital.

Recommendations for local actions emerging from a multi-disciplinary working group set up by Warwickshire Public Health and a one-day workshop to begin to focus on local needs and early actions for unintentional injuries prevention are presented.

Injuries Leading to a Hospital Admission in 0-14 Year Olds in Warwickshire – A review of hospital episode statistic data (PDF 2.7 MB)

Warwickshire Pharmaceutical Needs Assessment (2018)

The latest version of the Warwickshire Pharmaceutical Needs Assessment was published in March 2018.

This is the second ‘pharmaceutical needs assessment’ (PNA) prepared on behalf of the Warwickshire Health & Wellbeing Board  and Warwickshire’s third PNA. Since 1 April 2015, all Health and Wellbeing Boards have a legal responsibility to keep an up-to-date statement of the pharmaceutical needs for their population. PNAs are updated at least every 3 years.

The purpose of the PNA is to assess local needs for pharmacy provision across Warwickshire, to identify any gaps in service or unmet needs and to highlight any services that community pharmacies could provide to address these needs. Community pharmacies are at the heart of our communities and as such have an important role to play in improving the health and wellbeing of our population. The PNA can be used to identify and plan the current and future commissioning of services required from pharmaceutical providers including whether new pharmacies should be allowed to open or GPs allowed to dispense. It can also be an effective tool to promote pharmacy services to the population to improve the uptake of services and accessibility to health and wellbeing provision and advice.


Warwickshire Pharmaceutical Needs Assessment 2018 (PDF 2.7 MB)

Atherstone Place-based Needs Assessment (2017)

The Atherstone Place-based Needs Assessment has been published. 

This is a pilot of a programme of place-based needs assessments  approved by the Warwickshire Health & Wellbeing Board  to inform the strategic planning of local services.

The Atherstone needs assessment covers the Atherstone North, Atherstone Central and Atherstone South & Mancetter wards. It provides an overview of the demographics of the Atherstone population along with local data on health; social care; education; employment & income; crime & community safety; road safety & transport; environment & technology; and services. The report has been used by stakeholders in Atherstone to produce a list of recommendations to address issues raised and improve outcomes in the area. An action plan has been drafted and once agreed will be published on the JSNA website.

Atherstone Place-based Needs Assessment (PDF 5.15 MB)

Atherstone Place-based Needs Assessment Key Messages Infographic

Maternity Needs Assessment update (Coventry & Warwickshire, 2017)

The final draft of the updated Maternity Needs Assessment has been published.

In February 2016, the National Maternity Review published Better Births, a Five Year Forward View for maternity care which set out a vision for maternity services across England to become safer, more personalised, kinder, more professional and more family friendly. Following this, the Maternity Transformation Programme was launched in July 2016 to implement the vision set out in Better Births, supporting the Secretary of State’s ambition to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2030.

The CCG Improvement and Safety Framework 2016/17 baseline maternity assessment rates CCGs in England on improvement indicators for patient choice, experience, maternal smoking, and neonatal mortality rates, aligning with key themes from Better Births. There was considerable variation between CCGs, with almost 75% needing at least “some improvement” to maternity services – and 11 of these having “greatest need for improvement”, including South Warwickshire CCG. Only one, West Kent CCG, was rated as “top performing” with another 53 rated as “performing well”.

Locally, the focus of this needs assessment was to provide an updated picture on maternity need and services across Coventry & Warwickshire to inform the upcoming service re-commissioning under the banner of the Sustainability & Transformation Partnership (STP).

This report was commissioned by the Local Maternity System, as part of the Maternity & Paediatrics STP Workstream. This group is a partnership group from across the sub-region and includes a range of local stakeholders responsible for delivering maternity services.

This needs assessment and the arising recommendations will inform the action plan from this workstream and ultimately inform the recommissioning of maternity services across Coventry & Warwickshire in line with the vision set out in Better Births.

Maternity Needs Assessment update (Coventry & Warwickshire) (PDF, 1.8MB)

JSNA Place-based Profiler Tool (2017)

At Warwickshire’s Health & Wellbeing Board meeting on 6th September, the Insight Service launched a new interactive JSNA Profiling Tool.

The provision of a common evidence base across a consistent set of geographies will support all Health & Wellbeing partners to understand the health and wellbeing needs of Warwickshire’s communities, informing commissioning activity and strategic planning across health and social care, in particular, the Proactive & Preventative element of the Sustainability & Transformation Partnership (STP), the out of hospital programme, which seeks to build integrated services around populations of around 30,000 to 50,000, and transformation programmes relating to both adult and children’s services and community hubs.

The tool has been developed as one of the first outputs to be published under the JSNA place-based approach and includes the approved JSNA geographies. This is the first time that data covering a broad range of themes at a number of geographical levels, has been made available via a single tool and allows users to create statistical profiles across a number of different geographies and enables comparisons between areas and with county/sub-regional averages.

Please find a briefing note providing an overview of the tool, which summarises the themes covered, the geographies used and guidance on how best to use the tool to ensure its full functionality as well as a link to access the tool directly. Please continue to use this link to access the tool rather than downloading the spreadsheet as we’ll be making updates as new data becomes available.

This is the first version of the profiler tool and we welcome any feedback or comments. Our aim is to transition this to a web-based platform in the future.

There is also a mapping element which sits alongside the Excel-based tool. Where the information is available, this allows the user to view the indicator on a geographical basis. The mapping is currently in development and will be updated and added to going forward.

Quick links:

– Briefing note and profiling tools: https://apps.warwickshire.gov.uk/api/documents/WCCC-644-449

– To view the mapping tool if Internet Explorer is your default browser, please paste the following link into either Chrome or Firefox browsers: http://maps.warwickshire.gov.uk/jsna/

– To view the agreed 22 JSNA Geographies, please click on the following link to view a standalone map: JSNA Geographies Map

We hope that you find the tool useful and please send any feedback to insight@warwickshire.gov.uk

Exploring self-harm in young people in Warwickshire (2017)

Self-harm is a term used to describe the act of somebody intentionally causing injury or damage to themselves.

The UK has the highest rates of self-harm in Europe, with around 400 in 100,000 people reported as having self-harmed[1].  In addition to this, evidence suggests that self-harm rates are increasing.  There are reports of rates of self-injury (where somebody causes damage to their skin) quadrupling over a ten year period[2].

Warwickshire currently has a higher rate of self-harm than the UK (430.5 per 100,000 hospital admissions for self-harm in 10-24 year olds compared to 398.8 in England[3]).  Despite an increase in research into drivers and motivators of self-harm, the varied profile of Warwickshire (rural and urban areas with a varied socio-economic profile) means it is difficult to ascertain an overarching driver for this elevated rate.

During the development of Warwickshire’s Suicide Prevention Strategy, it was highlighted that a deeper look into local self-harm was required.  Self-harm is the strongest predictor of suicide with evidence suggesting that it increases the probability of someone dying by suicide by 50-100 times in the 12 months following[4]. In addition to this, it is widely recognised that there are a wide range of drivers and motivators for self-harm, not all of which correspond to suicide, and that these may require a different approach.  This needs assessment aims to investigate these further.

This needs assessment also aims to help better understand the needs of the young people (0-25 years old) in Warwickshire who self-harm.  It looks at the services currently available to those young people and makes recommendations on how to improve them based on current evidence and consultation with a range of stakeholders (including those with lived experience).

The Self-Harm Needs Assessment is available by clicking on the link below:

Exploring self-harm in young people in Warwickshire JSNA (PDF, 1.0 MB)

For more information, please contact insight@warwickshire.gov.uk


[1] Mental Health Foundation – https://www.mentalhealth.org.uk/a-to-z/s/self-harm

[2] Based on figures taken from Hospital Episode Statistics and the Health and Social Care Information Centre

[3] PHE Fingertips. Available at: https://fingertips.phe.org.uk/search/self%20harm#page/0/gid/1/pat/6/par/E12000005/ati/102/are/E08000025

[4] National Institute for Health and Care Excellence. Self-harm pathway 2016 [cited 2016 24 January]. Available from: http://pathways.nice.org.uk/pathways/self-harm#content=view-index

An Overview of Mental Health & Criminal Justice in Warwickshire (2017)

The Insight Service has produced a report which provides an overview of the mental health and offending picture in Warwickshire, highlighting the prevalence of mental conditions/concerns amongst offenders in the Warwickshire population.

The report also:

– Provides the national and local strategic/policy context regarding mental health amongst offenders
– Provides an overview of mental health in Warwickshire, with comparisons to national figures
– Provides an overview of the offending profile in Warwickshire
– Provides an overview of criminal justice services in Warwickshire
– Uses service level data, to help illustrate the mental health and well-being needs of Warwickshire adults in contact with CJS
– Identifies data gaps and limitations

The report can be viewed by clicking on the link below:

An Overview of Mental Health and the Criminal Justice System in Warwickshire (PDF, 875 KB)

For further information, please contact the Insight Service at insight@warwickshire.gov.uk

Health Needs Assessment for Warwickshire Children (2017)

Compass provides the Warwickshire School Health & Wellbeing Service (formerly known as the ‘School Nursing Service’). This confidential service is freely available to all school-aged children and young people from 5-19 years old (up to 25 years old for people with special educational needs) and their families and carers.

An integral part of the School Health and Wellbeing service is the universal contacts the team has with every school aged child including parents/carers. These are delivered via health questionnaires: at school entry (aged 4 to 5 years); and Year 6 (aged 10 to 11 years) to identify health related needs at individual, school, locality and population levels.

As a universal health service for school aged children (5-19/25 years with SEND), we believe it is important to share with partner agencies the aggregated population data that can help contribute to your own needs assessment, service planning and development on an annual basis.

The population data reports cover a range of topics:
– Universal Health
– Risk & Protective Factors
– Family Health
– Emotional Health & Wellbeing
– Lifestyle Choices
– Services and
– Choices.

The year six questionnaire has an additional lifestyle behaviours section that includes alcohol, smoking, drug use, solvent use and transition & feelings.

The first annual report for the School Health and Wellbeing Service covers the academic year 2015-16. Over the coming months, the Warwickshire population level health needs assessment data for the current academic year 2016-17 will be published.

The report is now available to download:

Annual Report for the Academic Year 2015/16 (PDF, 5.84 MB)

The data is now available summarising the anonymous results from the health needs assessments undertaken during the academic year 2015/16:

Health Needs Assessment – Entry level (PDF, 7.92 MB)

Health Needs Assessment – Year 6 (PDF, 8.36 MB)

This data is used at a school level to develop localised Health and Wellbeing Plans, including the identification of key priorities for that area and how the school will be supported by the service to meet the needs of the children and young people within that school.

For more information, visit the School Health & Wellbeing webpages. If you have any questions about this, please contact the commissioner, Kate Sahota (katesahota@warwickshire.gov.uk) or the service manager, Matt Conibere (matt.conibere@compass-uk.org).

Transport Needs Assessment (2017)

The aim of this needs assessment was to assess available transport and health data to ascertain the non-emergency transport needs of the population.  This information has been used to produce a set of recommendations relating to this topic.

The recommendations are evidence based following this work and act as a guide for transport and health colleagues when working to improve the services that exist, to enhance patient experience and reduce journey duplications and wastage across the County.

Main findings included:

– There is evidence to suggest that needs of the elderly population relating to patient transport are being met, however there is a need to ensure that advertising and awareness of these services reach those who are younger, such as single parents with limiting long term illnesses as an example.  This is important in ensuring that these groups of the population are able to reach medical appointments easily and safely.

– Demand for the services are high in those aged over 65, and especially in those aged over 75.  This can be seen by user data collected from the HWW survey in 2014.  This information also displays how important the users feel the services are in enabling them to reach appointments.  Demand may shift towards younger groups also, who need these services, if advertising is broadened.  Demand clusters around urban and centralised towns, however there is rural need, especially in North Warwickshire Borough, Stratford on Avon District and Rugby Borough.

– Supply of the services is good and many areas of Warwickshire, both rural and urban are served successfully by non-emergency patient transport.  Public transport supply is variable and there is more public transport in busier towns as opposed to more rural villages.  Therefore if patients are able to travel by public transport, they may still find the opportunities difficult in rural areas.  If patients are medically unable to travel in this way, public transport automatically becomes a method of supply that is unfeasible.

For a link to the full needs assessment please click here.

Youth Justice Service Needs Assessment (2016)

This Health and Wellbeing Needs and Assets Assessment (HWBNAA) has been undertaken at the request of Warwickshire’s Youth Justice Chief Officers Board, who have responsibility for the effective operation of the statutory Youth Offending Team (in Warwickshire this is team is called the Warwickshire Youth Justice Service). As the council is required to re-commission the health service currently provided, this has formed a key driver for the work. The assessment will also contribute to Warwickshire’s Joint Strategic Needs Assessment (JSNA) and as such the findings will be reported to both the Chief Officer’s Board and the JSNA Strategic Group.

It is anticipated that the findings will also inform the wider commissioning decisions of CCGs, Warwickshire County Council, NHSE and the office of the Police and Crime Commissioner (PCC).  It have have relevance for:
– The current Child and Adolescent Mental Health Service (CAMHS) review
– Local Transformation Plan
– Other children’s services plans
– Plans relating to substance misuse and other risky behaviours among young people
– Special Education Needs and Disability (SEND) reforms
– Priority Families Programme

To read the Executive Summary please click here.

To read the Full Report please click here.

Domestic Violence & Abuse Needs Assessment (2016)

The needs assessment has presented an in-depth analysis of the national and local picture of domestic violence and abuse (DVA). It aims to inform the ongoing development of Warwickshire’s response to Violence Against Women and Girls (VAWG) and in particular the re-commissioning of the county’s specialist DVA support services.The needs assessment has presented an in-depth analysis of the national and local picture of domestic violence and abuse (DVA). It aims to inform the ongoing development of Warwickshire’s response to Violence Against Women and Girls (VAWG) and in particular the re-commissioning of the county’s specialist DVA support services.

Key Findings and Emerging Themes

A summary of the key findings and themes that have emerged from the needs assessment are as follows:

  • Current specialist community based support and refuge services are not meeting the estimated DVA need in Warwickshire. This is demonstrated by the statistics and also by victim-survivor and practitioner feedback.
  • The existing specialist commissioned provision offers the right service elements but capacity needs increasing to improve quality and meet need.
  • The IRIS (Identification and Referral to Improve Safety) programme has proved to be an effective addition to the service provision in 2015/16 and should be maintained.
  • Particular gaps are evident in support for children affected by parental DVA and in programmes for perpetrators.
  • More and improved (coordinated) training in DVA awareness, identification and safe referral is a common theme.
  • An improved and more consistent response to DVA victim-survivors and their families is required in relation to access to housing and move-on accommodation.
  • More education for children and young people is needed alongside support for the teachers delivering it.

To read the Executive Summary please click here.

To read the full report please click here.

Smoking Needs Assessment (2016)

The Smoking Needs Assessment 2016 is intended to provide insight into the prevalence of smoking and tobacco use across Warwickshire and to explore the performance and equity of the local services tasked with helping people stop smoking in the county.

Smoking and tobacco consumption is the single largest cause of preventable illness, health inequalities and mortality in England. Smoking is one of eleven identified priority topics for the JSNA’s three year programme of work in light of the burden of avoidable disease that it places on the population as well as the associated avoidable costs. The existing contract for the delivery of Warwickshire’s Stop Smoking service finishes at the end of the 2016/17 financial year.

To read the needs assessment report please click here.

Special Educational Needs and Disability Needs Assessment (2016)

The SEND needs assessment brings together a wealth of work to understand the views and needs of children and young people with special educational needs and/or disabilities. Its primary purpose is to inform commissioning at both strategic and operational levels, so that services are tailored to need and based on evidence.

A child or young person has SEN if they have a learning difficulty or disability that means they need special educational provision or support to help them learn.  Under the Equality Act 2010, a disability is defined as ‘a physical or mental impairment which has a long-term and substantial adverse effect on their ability to carry out normal day-to-day activities.’ For further clarification on the definitions of SEND used in this report please go to Section 1.2 Definitions and Scope.

Please click here for the full report.

Preventing Children from Becoming Looked After JSNA (2016)

One of the 11 priority themes identified for the JSNA’s current programme of work is children looked after (CLA). These are children and young people for whom Warwickshire County Council is responsible, either by assuming parental responsibility under a legal order or planning care and support through a voluntary agreement with parents. Although some will make distinctions between terms, being ‘looked after’ in this document is also referred to as being ‘in care’ or ‘accommodated’.  This needs assessment will inform our strategic planning, commissioning and service development aimed at reducing the need for children and young people to come into care.

To reduce the numbers of children coming into care, we need to:

– Prevent children from entering care in the first place
– Have effective care plans for those who do come into care so that their time in care is either short or progressing towards the best possible outcome
– Have effective pathway plans for those leaving care, so that they continue to thrive when they leave the system and do not need to re-enter care (‘step down’)

The main focus of this needs assessment will be stage 1 – preventing entry into care in the first place. The needs of these children will overlap with those that have previously been in care and need support to stay out of care.  Part 1 of the CLA needs assessment focused on the current CLA population, changing trends over time, comparisons with other authorities, outcomes for CLA and care leavers, and predictions of future needs. It also began to look at the factors determining whether or not children come into care, by examining the relationship between deprivation and CLA numbers, and the education, health, and crime outcomes of children in care. Part 1 of the CLA needs assessment is available here.

Commissioning recommendations are below.  For the full list of recommendations, including operational, data and recommendations for further investigation please click the link below.

– An outcomes-based commissioning model should be developed, which focuses on preventing and reducing the need for children to be looked after. Services should be commissioned or provided based on the outcomes required, rather than around specific models of provision. Particular attention should be paid to the transition point between tiers 3 and 4 where services should be available with the specific aim of diverting children and young people from care.
– Develop and refine an agreed performance framework which is used by all relevant services (commissioned or provided internally) in order to measure performance in line with agreed outcomes, and be held accountable for their success in diverting children and young people from care. Service user feedback should be part of this performance framework.
– Interventions should be planned in line with the Child Poverty strategy, to help reduce the impact of poverty and social isolation on abuse and neglect. Particular focus should be on the areas of greatest deprivation (deciles 1 and 2), which can sometimes be hidden in our relatively affluent county. The north of the county is particularly vulnerable to this, with higher deprivation and higher recorded incidence of abuse and neglect.
– The council should plan early intervention services in conjunction with schools and universal health services. These services will often be the first point on the child’s journey, and we must ensure there are no gaps between these and any higher tier provision commissioned by the local authority.
– Outcomes and services should be grounded in evidence. Research consistently shows that early intervention and promoting resilience in children and families can help them manage their vulnerabilities and avoid the need for high-end intervention. Family dysfunction is still an issue for children entering care in Warwickshire. Interventions should therefore be aimed at improving and maintaining family relationships wherever possible.
– Where decisions are made about redesigning early intervention services, measures should always be put in place so that the impact of these decisions can later be evaluated.

To read the full Part 2 report please click here.

Smart Start (0-5s) Needs Assessment (2016)


The purpose of this needs assessment is to:

– Describe the economic case for investing in school readiness
– Describe the importance of school readiness
– Provide a descriptive analysis of school readiness in Warwickshire
– Identify the needs of Warwickshire’s families and gaps in provision of services and support available for 0-5s and their families
– Summarise the evidence of what works to improve school readiness in order to facilitate improvements in service planning and delivery
– Inform service development and commissioning of services to help improve the lives of Warwickshire’s 0-5s
– Provide recommendations on how school readiness can be improved in Warwickshire

Executive summary

– School readiness as measured by the ‘Good Level of Development’ is a comprehensive measure of a child’s cognitive and socio-emotional skills at reception age.
– Warwickshire is home to 37,974 children aged 5 and under. The boroughs of Rugby and Nuneaton & Bedworth have the highest numbers of 0-5 year olds in the county.
– In Warwickshire, approximately 1 in 3 children were not school ready in 2015.
– There were also evident inequalities in the attainment of certain groups, including children with special educational needs and those from poorer backgrounds.
– Although the goal of the Smart Start programme is to improve school readiness for all of Warwickshire’s 0-5 year olds, more targeted early intervention and support is needed for groups with a higher level of need, where inequalities in school readiness exist.
– The findings of this Needs Assessment and various pieces of engagement work undertaken (the Foundation Project) have identified a number of groups in Warwickshire with an ‘unmet need’.


– To try and mitigate the effects of child poverty by investing more heavily into services that have been shown to reduce the attainment gap between affluent and poor children (e.g. high quality early education).
– To ensure that services engage with expectant parents from deprived areas during the antenatal period to identify issues as and when they arise as well as to positively influence parents’ behaviours and lifestyles.
– To take into account those geographically isolated from 0-5 services and activities in future service planning.
– To work towards identifying cases of child abuse and neglect as early as possible, to prevent neglect from escalating into different forms of abuse and to reduce the length of time that these children are exposed to harm.
– To improve access to mental health services and support for two key groups in particular: those suffering low level mental issues and children below age 5.
– To increase the provision of antenatal services in Warwickshire including a greater information and advice offer for expectant parents.

To read the full report click here.

Cancer in Coventry and Warwickshire (2016)

The national cancer strategy ‘Achieving World-Class Cancer Outcomes’ is aimed at significantly improving the outcomes for people affected by cancer. It has an emphasis on prevention and proposes initiatives that span the patient pathway, emphasising the importance of earlier diagnosis and of ‘living with and beyond cancer’. The strategy acknowledges that cancer prevalence is set to grow rapidly; a consequence of an ageing population and increased survival. It also recognises that mortality rates are higher than they could be and that there is unacceptable variation in access to and patient experience of care.

This report uses routinely available data and aims to provide an overview of the key cancer statistics for Coventry and Warwickshire to support local commissioners in designing pathways and targeting interventions as well as enabling us to collectively enhance prevention and early detection. It focuses on data detailing incidence, mortality and survival at CCG and district and borough level, as well as including some detail showing the variability in measures at GP practice level. The data in this report is intended to complement the waiting times data and analyses that CCGs routinely use and will be enhanced through further analyses undertaken locally or by West Midlands Cancer Alliance.

The report is available using the following link below:

Cancer in Coventry & Warwickshire report (PDF, 4.8 MB)

For more information, please contact Berni Lee, bernilee@warwickshire.gov.uk

CAMHs Needs Analysis (2016)

The Child & Adolescent Mental Health (CAMHS) JSNA has recently been approved by the CAMHS Redesign Board and is another needs assessment published from the JSNA’s current work programme.

This piece of analysis complements the extensive JSNA on Children and Adolescent Mental Health Services in Warwickshire which was completed in 2013 and can be found here.

Much of the data and context in the previous needs assessment remains relevant; however, this piece of analysis recognises the limitations of national and local prevalence estimates and instead focuses on referral data from Warwickshire’s specialist CAMHS service covering a three year financial period from March 2013 – April 2016.

This data has been used to better understand the cohort of children in Warwickshire who require specialist CAMHS support and seek to understand some of the wider risk factors associated with children’s mental health.

Some of the key messages from the needs assessment include:

  • Warwickshire specialist (tier 3) CAMHS received just under 12,000 referrals, relating to 8,901 children and young people in the three years from April 2013 to March 2016.
  • The number of children referred to Warwickshire specialist CAMHS increases with age until its peak at children aged 15 years after which the numbers fall again.
  • Nuneaton & Bedworth had the greatest number of children referred to CAMHS (2,046 children or 23%); the district/borough in Warwickshire with the second greatest concentration of children. North Warwickshire had a much lower proportion of children referred to CAMHS (11%) compared to the rest of the county despite an average concentration of children (21%).
  • The presenting problems for children referred to CAMHS were recorded for a quarter of all referrals (2,303 children) in the three year period. Of that 25%, the average number of presenting problems recorded was seven and just over a quarter (27%) of those children were referred to CAMHS with at least one severe presenting problem.
  • The most common presenting problems were emotional difficulties (including anxiety, phobias and OCD) which were recorded for nearly four in five (80%) children (1,827 children) where it was recorded. One quarter (25%) of these children had co-occurring emotional difficulties.
  • The average age of children referred to CAMHS changes for some presenting problems, depending on the severity of the problem. For example, the average age of children presenting with selective mutism was 10.3 years, however, those who were presenting with severe selective mutism were 4.1 years younger on average at 6.2 years. Conversely, the average age of children presenting with OCD was 11.5 years, however those with severe OCD presented at an older age of 13.9 years.
  • For the purposes of this analysis, we were able to join 99.6% of postcodes provided by Coventry and Warwickshire Partnership Trust (CWPT) for Warwickshire CAMHS referrals data for the three year period (April 2013 to March 2016) to Mosaic; a customer insight tool for understanding household and customer types, allocating every household in the country to one of 66 categories.
  • Group M (Family Basics) households account for 6% of the Warwickshire population but represents over 17% of the current CAMHS referral profile. Conversely, Group N (Vintage Value) households account for 6% of the Warwickshire population but represent under 3% of the CAMHS referral profile. A Group M resident is over five times more likely to be referred to CAMHS than a Group N resident.
  • Mosaic allows us to distinguish between targeting volume and risk. The former targets the groups and types with the greatest number of people referred to CAMHS and the latter representing those most at risk of being referred. Three Mosaic types (M56, M55 and M54) feature in both the volume and risk profile. These three types represent just under 1,200 (or 13.4%) referrals:
    • M56: Solid Economy – Stable families with children renting better quality homes from social landlords
    • M55: Families with Needs – Families with many children living in areas of high deprivation and who need support
    • M54: Childcare Squeeze – Younger families with children who own a budget home and strive to cover all expenses.
        • Camp Hill, Nuneaton & Bedworth
        • Brunswick, Warwick
        • Newbold & Brownsover, Rugby
        • Sydenham, Warwick
        • Kingswood, Nuneaton & BedworthThe top five wards with the highest number of households with target Mosaic types (M56, M55, M54) are:

The needs assessment is available below:

Child & Adolescent Mental Health (CAMHS) Needs Analysis (PDF, 985 KB)

Place based Lillington Needs Assessment (2016)

The Lillington Regeneration Needs Assessment has been written by Public Health Warwickshire and supported by WCC’s Joint Working Group. The needs assessment provides a comprehensive analysis into the health and wider socio-demographic needs of the residents of Lillington. It maps the health intervention and health improvement services available to the residents of Lillington, and its purpose is to help inform commissioners and providers to influence service delivery change.

To read the full report please click here.

Some of the key messages from the needs assessment include:

      • In Crown Ward the numbers of hospital stays for alcohol related harm are statistically significantly higher than the average for England.
      • The housing data highlights that over half of the residents in Lillington East who are living in WDC owned social housing have been in rent arrears over a two year period between 2014 and 2015.
      • Lillington West has the highest proportion (24%) of lone parents, which is above the average for Warwick District, Warwickshire, and England.
      • The employment data highlights that Lillington East has consistently had the highest levels of youth unemployment, as well as the highest proportion of unemployed residents when compared to the average for Warwick District.
      • There are no formal financial support services in Lillington. The need section highlighted that Lillington East has the highest number of enquires to CAB for debt and housing and households have on average the lowest income levels. As this Lower Super Output Area (LSOA) also has the highest proportion of households without access to a car / van in Warwick District, it may benefit residents if a CAB or similar service was based in Lillington on a regular basis.
      • Some of the retail provision in the shopping precinct promotes unhealthy lifestyle choices – for example the betting shop and the prevalence of hot food takeaways. Obesity levels are high in some LSOAs in Lillington. There could be a restriction placed on the number of hot food takeaways in the area, or owners should be encouraged to provide healthy options on menus.
      • A lack of a community hub offering a range of services was a key concern that came out at the stakeholder focus group. The tenancy questionnaire highlighted that the library is the most well-known and well visited service. This would suggest that the library may be best placed to house a community hub.
      • Drug and alcohol commissioners should work closely with the police and other public sector bodies to address the ease of access to drugs in some parts of Lillington.
      • Mental health issues such as social isolation, stress, and depression were reported as the main health and wellbeing challenges facing the population of Lillington.
      • As well as feelings of social isolation, views from stakeholders were that the flats in Crown Way felt like an unsafe environment to be in, and that the design was a contributing factor to feeling unsafe. This was because of the lack of connectivity / over-looked spaces, which can enable criminal activity to take place unseen. Creating environments which design-out crime are important to improving community cohesion, and it is recommended that communities are developed with Public Health Warwickshire’s planning guidance document in mind.
      • In terms of green space, stakeholders felt that connectivity to green spaces needed to be improved. Responses from the youth centre questionnaire also highlighted the importance of parks for health and wellbeing. Regeneration should consider improving access to green spaces and parks by improving walking / cycling routes. For mental and physical health and wellbeing, plans should also consider installing green gyms in parks and green spaces too.
      • The stakeholder consultation identified a gap in service provision for children aged 5-10, who are too young to attend the youth centre, and too old for the 0-5 agenda. This age group is therefore being disadvantaged at a key stage of their development. Linking in with the local school / after school club activities should be considered to address the service gap.

Children Looked After (CLA) Needs Assessment (2016)

JSNA logosThe Children Looked After (CLA) JSNA has recently been approved and is another needs assessment published from the JSNA’s current work programme.

The recommendations from the needs assessment are currently being worked into an action plan to inform practice, service development and the commissioning of services to support children looked after in Warwickshire to improve their lives and future opportunities.

This needs assessment is intended to provide insight to better understand Warwickshire’s profile of children looked after. This work dovetails closely with the Prevention JSNA aimed at preventing and reducing the numbers of children coming into care which is due to be approved in July 2016.

Some of the key messages from the needs assessment include:

      • The number of Children Looked After (CLA) in Warwickshire has risen by 8% over the last four years (to 31 March 2015). The CLA rate in the county is higher than the equivalent national and statistical neighbour averages but lower than the regional rate (see page 15).
      • There is significant variation in CLA rates across the county. At district/borough level, Nuneaton & Bedworth has significantly higher rates than Stratford-on-Avon and Warwick (see page 17).
      • There has been consistent numbers of children coming into care and the data suggests that the rate of entry is higher than the rate of children leaving care, so the numbers of children and young people in care in Warwickshire is rising (see page 25).
      • Population projections indicate that if the rate of CLA remains the same, by 2025 Warwickshire will have 50 more children looked after than at March 2015 (see page 29).
      • Research from Sheffield University suggests an ‘inverse care law’ in that more affluent Local Authorities intervene in children’s lives more than relatively disadvantaged Local Authorities for the same level of deprivation. When compared with its statistical neighbours, Warwickshire has the third highest CLA rate in 2015, yet is the 8th most deprived out of its 11 statistical neighbours so there may appear to be some truth in this from a Warwickshire perspective (see page 21).
      • Warwickshire consistently has a higher proportion of UASC in its CLA population compared to the national average (see page 34).
      • Warwickshire has higher proportions of CLA placed in independent living and residential settings (children’s homes, residential schools) than 5 years ago (see page 41).
      • The rise in CLA over the last five years has been greater than the rate of growth in local authority fostering services. As a result, a higher proportion of CLA are now placed with agency carers than five years ago (see page 41).
      • At March 2015, just under 65% of CLA were placed within Warwickshire and over nine in ten (91%) CLA were placed either in Warwickshire or in a neighbouring local authority (see page 45).
      • The proportion of CLA placed in foster care placements out of county increases with age, suggesting that Warwickshire has fewer foster placements than the county requires for older CLA (see page 44).
      • Educational attainment for CLA remains lower than for their non-looked after peers even at the earliest stage of assessment (see page 59 onwards).
      • CLA have the same core health needs as their non-looked after peers, but their background and experiences are likely to make them more vulnerable to poorer health outcomes (see page 67).
      • The proportion of CLA continuing to be looked after following their 16th birthday has increased over the last five years, from 45% to 69% (see page 81).
      • The needs assessment and presentations are available below:
      • Children Looked After JSNA – Key Messages Prezi presentation (Prezi – copy and paste link into Google Chrome)
      • Children Looked After Needs Assessment (PDF, 1.9 MB)
      • For more information on this work, please contact insight@warwickshire.gov.uk

Carers Needs Assessment (2016)

The Carers JSNA is the second completed needs assessment of the JSNA’s 2015-2018 work programme. It will be used to inform the upcoming recommissioning of adults carer services in Warwickshire and the emerging carers strategy, based on the needs identified.

This needs assessment is intended to provide insight into the unpaid care provision across Warwickshire and the extent and nature of local support services.

It will also support in planning to meet future demand as a result of the Care Act. Unpaid carers make an important contribution to the overall supply of care services.
Carers JSNA infographic

Key messages from the needs assessment include:

      • The Census indicates that Warwickshire has 59,240 people or 11% of the population providing some form of unpaid care each week in 2011.
      • Women are much more likely than men to provide unpaid care (58% and 42% respectively).  One in four women aged 50-64 years provides some level of unpaid care.
      • An estimated 108,000 patients registered with a Warwickshire GP had some form of caring responsibility in 2013/14.
      • This represents a significant difference when compared with the 2011 Census, with GP practices effectively identifying nearly twice as many carers in Warwickshire than the 2011 Census.
      • Many carers do not recognise themselves as carers. Research suggests they simply see themselves as husband, wife, parent, son, daughter or friend and as a result do not access formal services; this is identified as a particular problem with black and minority ethnic (BME) carers.
      • The number of older people in need of care is predicted to outstrip the number of family members able to provide it for the first time in 2017. By 2032, there is predicted to be an increase of 60% in the number of older people needing care from their families but the number of people able to care for older parents will have increased by only 20 per cent, creating a shortfall in capacity to care for older generations.
      • Applying population projections to the number of carers identified in the 2011 Census means that the number of carers is estimated to increase by just under 5,000 by 2021 to 64,120 carers in Warwickshire, with the majority of these (over four in five) expected to be aged 65 years and over (3,930).
      • There is a uniform pattern of deteriorating general health with rising levels of unpaid care provision. There is a clear relationship between poor health and caring that increases with the duration and intensity of the caring role.
      • There is a positive relationship between those providing more care in the more deprived areas of the county i.e. those areas that are relatively more deprived are more likely to have more residents providing 50 or more hours of care per week.
      • The 2011 Census shows 1,124 children aged 0-15 years and 2,562 young people aged 16 to 24 years are providing unpaid care in Warwickshire, approximately 2.3% of all children and young people in the county.
      • Young carers who care for 50 hours or more per week are five times more likely to report their health as ‘not good’ compared to those of the same age providing no care. This implies that high levels of unpaid care have a greater adverse effect on the health of young people.
      • The needs assessment and presentations are available below:
      • Carers JSNA – Key Messages Prezi presentation (Prezi – copy and paste link into Google Chrome)
      • Carers JSNA – key messages presentation (Powerpoint, 3.8 MB)
      • Carers Needs Assessment (PDF, 1.7 MB )

For more information on this work, please contact insight@warwickshire.gov.uk.

Helping Vulnerable Children Needs Assessment (2015)

Vulnerable Children infographicThe Helping Vulnerable Children Needs Assessment is the first completed needs assessment of the JSNA’s 2015-2018 work programme. It has been used to inform the development of Warwickshire’s Priority Young People Strategy as well as providing a broader context across the children’s agenda.

There is no single approach to defining vulnerability in children. In some cases, ‘vulnerable’ is used to define key groups of children, such as looked after children and young carers. In others, vulnerable is used to define children at risk of harm and neglect. The pressures and adversity that vulnerable children face will increase the chances of them taking part in risky behaviours and likely worsen their health and life outcomes. Relative to other young people, many of these vulnerable and disadvantaged groups are more likely to be unemployed, to be socially isolated, to commit crimes and to live in poverty.

To gain a picture of the potential cohort of vulnerable children in Warwickshire, each of the key groups considered in the needs assessment have been aggregated. It is worth emphasising that there is likely to be both overlap in these groups as well as a hidden population of vulnerable children in Warwickshire, potentially on the periphery of contact with public sector agencies.

Warwickshire’s population of vulnerable children is somewhere between 12,760 children (if every vulnerable child was living in out of work benefit claimants households) and 41,496 children (if every child in each group was unique).

Key messages from the needs assessment include:

      • In 2014, there were an estimated 118,800 children and young people aged under 18 years in Warwickshire.
      • Over the next ten years, Warwickshire’s 0-18 year old population is projected to increase by 6%, over 7,000 people. The largest expected growth will be seen in the 5-13 year age group, expected to grow by nearly 10% by 2024.
      • The latest small area population estimates (mid-2013) suggest that there are approximately 7,717 children aged 0-18 years living in the areas in Warwickshire which fall into the 20% most deprived nationally.
      • The rate of hospital admissions for self-harm among young people in Warwickshire has doubled from 164 per 100,000 in 2007/08-2009/10 to 354 per 100,000 in 2010/11-2012/13.
      • There is a clear gap between the educational attainment of the majority of children and those from particular groups that are vulnerable to underachievement. This gap is often detectable at as young as 22 months and widens throughout the education system.
      • The proportion of 16-18 year olds who are NEET in Warwickshire rose in 2013/14 for the first time in seven years to 5.5% of 16-18 year olds (estimated 1,010 young people). In 2014/15, it fell slightly to 5.1% but it is still above the national average (4.7%).
      • The needs assessment and presentations are available below:
      • Helping Vulnerable Children Needs Assessment – key messages presentation (Prezi – copy and paste link into Google Chrome)
      • Helping Vulnerable Children Needs Assessment – key messages presentation (Powerpoint, 1.4 MB)
      • Helping Vulnerable Children Needs Assessment (PDF, 2.4MB)

For more information on this work, please contact insight@warwickshire.gov.uk.

Veterans Mental Health Needs Assessment (2015)

VeteransLord Ashcroft (2014), in his review of veteran transition, highlighted that veterans are considered to be no more susceptible to mental health problems, compared to the general population and considers the media focus on Post Traumatic Stress Disorder (PTSD) as disproportionate.Evidence suggests however, that Common Mental Health (CMD) disorders (depression and anxiety) are thought to be over twice as common in those who have served in the Armed Forces (Goodwin, 2014), compared to the general population.  Pre service experience and childhood adversity (considered important risk factors), family relationships and a culture of heavy alcohol consumption are issues that compound mental health problems in veterans (Goodwin, 2013; Iverson, 2007 and MHF, 2010).

Following the adoption of the Armed Forces Community Covenant in 2012, there has been an enhanced focus on the needs of veterans, current serving Armed Forces personnel and their families across Warwickshire.

Mental health has been raised as an area of interest and this needs assessment identifies areas of focus for providers to improve the outcomes and services available to veterans in Warwickshire.

This needs assessment forms part of the ongoing work under the remit of Warwickshire’s Joint Strategic Needs Assessment (JSNA) and was endorsed by the JSNA Commissioning Group in December 2015.

The needs assessment and presentation are available below:

For more information on this work, please contact Emily Fernandez (emilyfernandez@warwickshire.gov.uk)

Loneliness & Social Isolation Needs Assessment (2015)

Warwickshire's JSNALoneliness and social isolation is associated with harm to mental and physical health, as well as having broader social, financial and community implications. Because of this, there has been a local, national and international consensus that support needs to be provided to individuals and communities in order to tackle loneliness and social isolation.

Whilst loneliness and social isolation is a problem present across all age groups in society, it is a significant and growing issue for older people in particular. It is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years, so it is important that we intervene now in order to address loneliness and social isolation.

With reducing budgets and projected increasing demand for services, identifying successful and cost effective early interventions, particularly involving sustainable community and volunteering approaches and initiatives, will present good opportunities for improved outcomes to combat loneliness and social isolation in the future.

The following report has been produced to identify loneliness and social isolation across Warwickshire and represents a needs assessment which has relevance to stakeholders across health and social care:

For more information, please see the dedicated webpage on Loneliness & Social Isolation in Warwickshire.

Best Health for Older People in Warwickshire Report (2015)

reportThis report entitled ‘Best Health for Older People in Warwickshire, 2015’ provides statistical intelligence around the health and wellbeing of Warwickshire’s older population. It aims to provide insight and knowledge of the circumstances and challenges the older population and those who support their health experience.The report has been produced jointly with Age UK Warwickshire and is a reminder to agencies providing health and social care in Warwickshire to work innovatively and collaboratively to support our older people.

Highlights from the report include:

      • Warwickshire has an above average proportion of older people, with over 20% of the total population aged 65 and over.
      • Life expectancy for males is 79.4 years and 83.1 for females
      • Females have longer life expectancies but a shorter healthy life expectancy (66.3 years) than males (67.0 years). Females are spending relatively less time (79.0%) than males (83.7%) in ‘good’ health.
      • With an ageing population, the issue of loneliness and social isolation has emerged as a major public health challenge
      • Long-term conditions are the ‘invisible epidemic’ for the older population
      • Warwickshire has a greater dementia prevalence projection than England; there will be an estimated 18.2% increase in cases by 2020 (3,200 new cases)
      • The number of carers has remained relatively stable, but the hours of care provided has increased

The full report is available by clicking on the link below:Best Health for Older People in Warwickshire Report (PDF, 1.7MB)

Learning Disabilities Needs Assessment (2015)

Warwickshire JSNAThe Learning Disabilities Needs Assessment was produced as part of the JSNA programme of ongoing work and has recently been approved and signed off by the Coventry and Warwickshire Learning Disabilities & Autism Commissioners Group. It has informed the production of a new Learning Disabilities Statement of Intent for Warwickshire covering the period from 2015 to 2020, focusing on adults and young people in transition. Commissioners have benefited by having access to robust evidence to support or question the applicability of suggested models of care for people with learning disabilities now and in the future. Many of the recommendations from the needs assessment have already been actioned through the development of Warwickshire’s Learning Disability Self-Assessment Framework Action Plan, Warwickshire’s Learning Disability Statement of Intent and Warwickshire’s recent Transforming Care Fast Track bid. Individuals with a learning disability are described in the 2001 Government White Paper ‘Valuing People’ as having a significantly reduced ability to understand new or complex information and learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning), which started before adulthood and had a lasting effect on their development. Rights, independence, choice and inclusion are the overarching messages within national policies, however, people with learning disabilities often experience many disadvantages and poor outcomes and are a vulnerable group in society. The true picture of the number and identity of people with learning disabilities in Warwickshire is poorly understood. Figures based on social care returns and/or school census data alone significantly under-estimate the true prevalence of learning disabilities due to limited school level reporting and the likelihood of a ‘lost’ population with a learning disability who are unknown to social services. Warwickshire has an older resident population than the England average, and this combined with reduced mortality among older adults with learning disabilities is likely to lead to higher demand for services over the next decade. Key messages from the needs assessment include:

      • The total estimated prevalence of all people with a learning disability in Warwickshire in 2013 was 11,030 of whom 9,469 are adults aged 18+ and 1,561 are children & young people aged 0-17 years.
      • Approximately two-thirds of adults with learning disabilities expected to be in contact with social services are receiving a service from social care in Warwickshire.
      • People with learning disabilities have significantly worse health than their non-disabled peers.
      • In 2013/14, 57.5% of adults with learning disabilities in Warwickshire received an Annual Health Check.
      • The number of people with a learning disability is likely to increase by 1% per year over the next 15 years due to increased life expectancy & increasing numbers of children with complex needs surviving into adulthood.
      • The number of adults with learning disabilities with a critical or substantial need using social care services is estimated to increase by 1.7% year on year to 2030.

A presentation on the key findings from the needs assessment is available using the link below as well as the full needs assessment:

Learning Disabilities JSNA Needs Assessment – Key Messages presentation (please open this link in Google Chrome to view this presentation)

Learning Disabilities JSNA Needs Assessment

Pharmaceutical Needs Assessment (2015)

pharmacistThe purpose of a Pharmaceutical Needs Assessment (PNA) is to present a picture of pharmaceutical service provision, reviewing access, range and adequacy of service provision and choice of provider.

The PNA is an assessment of the need for a type of service rather than a service provided by a particular type of contractor. Pharmaceutical services can be provided by Dispensing Doctors, Dispensing Appliance Contractors, Local Pharmaceutical Service Contractors as well as Community Pharmacies.

Following the Pharmaceutical Needs Assessment consultation,  the below documents are now available.

Warwickshire Health & Wellbeing Board’s 2015 Pharmaceutical Needs Assessment (PDF, 1.6KB)

Warwickshire Health & Wellbeing Board’s 2015 Pharmaceutical Needs Assessment, Executive Summary (PDF, 224KB)

For more information on the PNA and the appendices, see the Pharmaceutical Needs Assessment page.

Child Sexual Exploitation (CSE) Needs Assessment (2014)

teenager with phoneNational awareness of child sexual exploitation (CSE) was raised initially as a consequence of the trial and conviction in November 2010 of a group of men who sexually exploited children and young people in and around Derby.  Consequently, it is now a requirement of Local Safeguarding Children’s Boards to understand the prevalence of CSE in their area. This report, published in May 2014, assesses that prevalence as Warwickshire had not undertaken this work before.  It reflects a point in time, given the information known at that time, but is limited by what professionals knew about the young people at the submission date. For the full report please use the following link:

Understanding Child Exploitation in Warwickshire (PDF, 1.2MB)

99 children and young people were classified by professionals as being, or potentially being, exposed to child sexual exploitation (CSE).  However, it is known that there are a further 101 young people (new information provided after publication) who were identified as being or potentially being at risk of CSE by two partners but not submitted via the data collection form. NSPCC prevalence figures would suggest that Warwickshire has between 4,900 and 15,800 young people under the age of 16 who are at risk of CSE.  Therefore this exercise has only identified a small proportion thought to be at risk.  A CSE subgroup of the Warwickshire Safeguarding Children’s Board is undertaking work to ensure the intelligence generated from this report is implemented to help keep Warwickshire’s children safe from CSE.

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