In order to fully understand the health and social care needs of children in Warwickshire, it is important to provide some context in terms of their demographic and socio-economic make-up. This forms the basis against which other data can be analysed, helps to identify inequalities and is a key building block in modelling service requirements.
What are the big issues?
According to the mid-2016 population estimates, there are approximately 125,554 children and young people aged 0 to 19 years living in Warwickshire, which equates to 23% of the total population. This proportion is below the equivalent national and regional figures. Across Warwickshire’s districts and boroughs, Warwick District (30,714) has the largest number of children aged 0 to 19 years, closely followed by Nuneaton & Bedworth Borough (30,154). Rugby Borough has the largest proportion of its total population aged 0 to 19 with one in four falling into this particular age group (25%). In contrast, in Stratford-on-Avon, 21% of the total population are aged between 0 and 19.
According to the January School Census 2017, the vast majority of the maintained and academy school population in Warwickshire are of White British ethnic origin (82%), and the largest minority ethnic groups are Asian (6%), Any Other White Background (5%) and Mixed (4%).
The largest demographic issue facing the county is that of a rapidly ageing population. In comparison, the total child/young people population in Warwickshire is projected to increase by a much lower rate according to the 2014 based ONS projections. The population aged between 0-14 years is expected to grow by 6.7% in the 25 year period from the 2014 base; however the population aged between 16-64 years is only expected to grow by 0.1%. The Warwickshire population aged 65 years or over is expected to increase by over half (54.4%) over 25 years and when we consider the population aged 90 years or over, this is expected to increase substantially by 269%. However, this projected growth is not insignificant and has a range of future policy implications in terms of increased demand for those services provided for children and young people.
Local analysis shows that 9.9% of mothers in Warwickshire were recorded as smokers at the time of delivery (SATOD) for 2016/17, which is comparable to the England rate (10.7%). Evidence has demonstrated that babies born to women who smoke during pregnancy are around 40% more likely to die within the first four weeks of life than babies born to non-smokers. SATOD reflects the link between smoking and health inequalities and is a precursor to initiating smoking in adolescence. Smoking status at the time of delivery (SATOD) data is not available at district/borough level, however it is available at CCG level for all except Warwickshire North CCG (due to a data quality issue). Coventry and Rugby CCG has a higher proportion of women smoking at time of delivery (10.9%); in South Warwickshire CCG the proportion is 7.6%. Reducing smoking in pregnancy is a key priority within Warwickshire and a priority theme for the ‘Smoke Free Warwickshire Alliance’.
Injuries represent a major cause of premature mortality for children and young people. They are also a source of long-term health issues. In 2016/17, the rate of hospital admissions as a result unintentional and deliberate injuries in children (aged 0-14 years), was higher in Warwickshire (119.0 per 10,000) than for England (101.5 per 10,000). Warwick District has the highest hospital admission rate for unintentional & deliberate injuries (aged 0-14 years) in the County (156.2 per 10,000). This rate is significantly worse than the England average (101.5 per 10,000). By way of comparison North Warwickshire Borough has the smallest rate in the County, at 103.1 per 10,000 resident population.
Younger carers (aged between 0 and 24 years) are identified as of particular concern in Warwickshire because of the potential impact of caring responsibilities on educational outcomes and wider social opportunities. Young carers have much lower educational attainment at GCSE level and those aged 16-18 are twice as likely as their peers to be not in employment, education or training (NEET). Also, high levels of unpaid care have been found to have adverse effects on the health of young people. Nuneaton & Bedworth Borough has the highest proportion of young carers providing 20 or more hours of unpaid care a week. Young carers (0-24 years) are twice as likely to report that their health is ‘not good’ compared with their peers who provide no care. This difference increases with time spent caring, with young carers caring for 50 hours or more per week; 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.
Hospital admissions for self-harm in children have increased in recent years, with admissions for young women being much higher than admissions for young men. The rate of hospital admissions as a result of self-harm in young people in Warwickshire is significantly higher than both the England (404.6 per 100,000) and West Midlands rate (413.9 per 100,000).
The UK is experiencing an epidemic of obesity affecting both adults and children. Studies tracking child obesity into adulthood have found that the probability of overweight and obese children becoming overweight or obese adults increases with age. Health consequences of childhood obesity include: glucose intolerance & type 2 diabetes. North Warwickshire Borough has the largest proportion of obese children in the county of reception age, however this is not significantly higher than the figure for England. Nuneaton & Bedworth Borough has the largest proportion of obese children in the County, in year six, also not significantly higher than the figure for England. Conversely, Stratford-on-Avon District has the smallest proportion of obese children in the County at reception age. At year 6, Rugby Borough, and Stratford-on-Avon and Warwick Districts all have a similar low proportion of obese children, which is significantly lower than the England figure.
There is concern about the rise of childhood obesity and the implications of such obesity persisting into adulthood. These implications are not just physical, given that childhood obesity can lead to psychological problems such as social isolation, poor self-esteem and bullying.
The health and wellbeing of Warwickshire children is vital in ensuring the future success of the County. The Warwickshire Joint Strategic Needs Assessment (JSNA) identifies the current and future health & wellbeing needs of the local population. The JSNA aims to establish a shared, evidence based consensus on key local priorities across health and social care, and is being used to develop Warwickshire’s Health and Wellbeing Strategy, commissioning plans for the CCGs and transformation plans for the local health economy.
Teenage pregnancy and early motherhood have been associated with poor educational attainment, poor physical and mental health, and deprivation. The UK has the highest teenage birth rate in Western Europe, and an estimated £63 million a year is spent by the NHS on teenage pregnancies. In 1999 the government introduced the Teenage Pregnancy Strategy, which aimed to half the national under-18 conception rate by 2010. Since then, the under-18 conception rate has continued to decline.
Within Warwickshire, Stratford-on-Avon District has the lowest conception rate per 1,000 women aged 15 to 17. When looking at the proportion of under-18 conceptions that have led to abortion, Warwick District has the highest proportion (76.5%), whist Stratford-on-Avon District has the lowest (52.2%).
Due to the relatively small numbers, there can be spikes in the conception rates when looking at one particular year. Nuneaton and Bedworth Borough saw an increase of +13.3 between 2013/14, placing the Borough as the worst (highest) ranking area for under 18 conception rates in England and Wales. However this reduced by -17.6 between 2014/15 and the most current figure is not significantly different from the England figure. Overall the rate is declining since 1998 in all boroughs and districts in Warwickshire.
Who needs to know?