SolihullJSNA:Contents
Introduction Approach and Production of 2012 JSNA NHS and Public Health Reforms Health and Wellbeing Board 1
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People and Place Age Profile Population Projections Migration Ethnicity Religion Day Time Population Vulnerable People and Other Demographic groups Physical Disability Learning Disability Mental Health Carers Visual and Hearing Impairment Deprivation The Living Environment Urban/Rural Classification The Built Environment and Infrastructure ‐ Housing Provision and the Housing Market Potential Challenges For Consideration 4
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Best Start in Life Key Findings Introduction Families and parenting Early Years and School Readiness Fertility Mortality Smoking and Excess Alcohol In Maternity Low Birth Weight Screening and Immunisation Breastfeeding Children’s Disability Childhood Obesity Demographic Change Emotional Health and Well‐being Child Protection Looked After Children Care Leavers 15
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Wider Determinates of Children’s Well‐being Safeguarding in Families Child Sexual Exploitation Hospital Admissions Reach of Children’s Centres 37
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Capabilities and Control Key Findings Introduction Transforming Adult Social Care Demographics and Need Key Client Groups Carers Types of Clients Distribution of Social Care Clients In Solihull User Perceptions Of Adult Social Care Services In Solihull Adult Social Care Performance Costs Service Developments Providing Individuals with the Tools to Make Informed Health Care Choices Education Health Literacy Support Groups and Community Information and Access to Services 43
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Employment Key Findings Employment and Health Local Economic Conditions and the Supply of Jobs Supply of Jobs and Resident Employment Employment Participation and Worklessness Profile Worklessness Drivers and Barriers to Employment Lower Skilled Individuals Young People Lone Parents Ex Offenders Health, Disability and Mental Health Health and Safety in the Workplace Employer Based health Promotion 78
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Healthy Standard of Living Key Findings Poverty Segmentation 103
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Closing the gap of Inequality Health Context of Inequality Housing Health Related Housing Volunteering 111
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Sustainable Place and Communities Key Findings Community Safety Regenerating North Solihull Accessibility Local Development Framework Sustainability and Climate Change Community Capacity 134
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Ill Health Prevention Key Findings Life Expectancy Mortality and Morbidity Lifestyles Smoking Physical Activity Excess Alcohol Substance Misuse Sexual Health Availability of Affordable Healthy Food Obesity Oral Health Disease Groups Cancers Communicable Diseases Disease Prevalence Models Cardiovascular Disease (CVD) Coronary Heart Disease (CHD) Stroke Hypertension Chronic Kidney Disease (CKD) Respiratory Disease Chronic Obstructive Pulmonary Disease (COPD) Diabetes Genetics and Genomics 154
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Ill Health Prevention – Health Protection Annex 189
Health and Well Being Strategy and the Benefits of investing in Transport Projects 206
Introduction
Approach and Production of 2012 JSNA The Joint Strategic Needs Assessment (JSNA) has been defined as: A systematic method for reviewing the health and wellbeing needs of a population, leading to agreed commissioning priorities that will improve outcomes and reduce inequalities. This new edition of Solihull’s JSNA (February 2012) is an interim response to support the requirements of the newly established Health and Well Being Board, which will be publishing a Health and Wellbeing Strategy which in turn will drive all health and wellbeing strategic commissioning in the local area. As such this version of the JSNA has been compiled using existing data sources/reports and will be updated in September 2012 with additional in‐depth analysis of key topics. Key customers for the JSNA have been identified as Public Health (Local Authority) and the GP Consortia. Another key customer of the JSNA is the proposed local HealthWatch which places importance on the need for transparency, independence and objectivity. In development of Solihull’s JSNA has been based on the following guiding principles: •
Define and deliver achievable improvements in health and well being for local community; •
Influence priority setting, decision making and the identification of population outcomes; •
Signal to current and potential providers changes in service provision that will be required to achieve these improvements; •
The JSNA is an ongoing, iterative process – the information resource will build over time; •
The information will be updated as data becomes available to ensure that the JSNA remains ‘live’; •
The JSNA is not a commissioning plan – however it is essential that it informs commissioning. In the course of producing this JSNA an initial consultation on the priorities for needs assessment and commissioning information was undertaken, including a multi‐agency JSNA workshop in November 2011 to ensure engagement with a wider group of stakeholders. A draft was circulated draft within the council, the Clinical Commissioning Group, service providers, and 1 the Community and Voluntary Sector to help to identify information gaps and the need for more in‐depth analysis, to improve our understanding of the initial findings, and to confirm priorities. This will be an ongoing an iterative process, feeding in to the September 2012 refresh. The structure of the 2012 JSNA follows the ‘Marmot Policy Objectives’ which are the basis of ‘Fair Society, Healthy Lives: The Marmot Review’ which set out a strategy for reducing health inequalities. The Marmot Review is particularly valuable in that its recommendations are based on a comprehensive assessment of the evidence base of what is effective in improving health and reducing inequalities. These policy objectives are: 1. Give Every Child the Best Start in Life; 2. Enable All Children, Young People and Adults Maximise Their Capabilities and Have Control Over Their Lives; 3. Create Fair Employment and Good Work For All; 4. Ensure a Healthy Standard of Living For All; 5. Create and Develop Healthy and Sustainable Places and Communities; 6. Strengthen the Role and Impact of Ill Health Prevention. It is therefore desirable that the JSNA should simultaneously provide in summary a simple agreed picture of need and sufficient detail of all areas that might make a major contribution in promoting health and well‐being (including insight into how we might improve the health of the poorest fastest). This breadth could for instance consider; worklessness, fuel poverty, early years development, education, lifelong learning, active travel, quality of the local environment, social networks, healthy lifestyles, occupational health, personal safety, and housing. This approach augments the epidemiological insight that has been a feature of previous assessments. NHS and Public Health Reforms The development of this JSNA is consistent with the local requirements of the public health reforms implemented by the Coalition Government. In July 2010 the Government published its proposals to reform the NHS in its White Paper ‘Equity and Excellence: Liberating the NHS’. This was followed in November 2010 by the publication of the public health White Paper ‘Healthy Lives, Healthy People: Our Strategy for Public Health in England’. These White Papers included proposals that have significant responsibilities for local government: 1. To transfer certain public health responsibilities and leadership for improving health to local government; 2. To establish a Health and Wellbeing Board responsible for coordinating and integrating health and wellbeing services; 3. To lead the development of a Joint Strategic Needs Assessments and Health and Wellbeing strategies; 4. To ensure that the Health & Wellbeing strategy drives strategic commissioning for health and wellbeing in the local area. 2 Health and Wellbeing Board The Council approved the establishment of a Shadow Health and Wellbeing Board at its April 2011 meeting. The main role of the Board is to promote the health and wellbeing of the population of Solihull by coordinating the commissioning of health and wellbeing services and promoting the integration of services. It achieves this by overseeing the development of a health and wellbeing strategy based on an assessment of need (through the Joint Strategic Needs Assessment). The Board has met regularly since April 2011 and has begun work on the identification of shared health and wellbeing priorities which will form the basis of the strategy. The future work programme and forward plan identifies the following priorities: • Development of the Health and Wellbeing Strategy informed by the Joint Strategic Needs Assessment; • Development of the ‘Ageing Well’ element of the Health and Wellbeing Strategy, drawing on a project that has been undertaken with the support of the Local Government Association; it is intended to use this opportunity to ‘test’ the ability of the Board and the new collaborative arrangements to make an impact on a priority topic; • Ensuring that the Board becomes an effective body supported by a Board development programme (e.g. it has joined the national Health and Wellbeing Board Development Learning Network). • Other topics to be covered include: Oral Health Strategy; Young Carers Scrutiny Report; Fuel Poverty Report; Drug and Alcohol Commissioning Strategy/Commissioning Plan; development of performance monitoring.
3 Age Profile
The population of Solihull is, according to ONS mid-2010 estimates, 206,100 (100,100 males and
106,000 females), having increased by 3.3% since the 2001 Census. This compares with population
increases of 5.6% in England and 3.3% also in the West Midlands over the same period.
The most notable feature of the Solihull population profile is the relatively higher proportion of older
people in the borough, with 18.8% of the population aged 65 and over compared with 16.5% in
England and 17.2% in the West Midlands. Solihull also has an above average representation of
people approaching retirement age (27% aged 45 to 64 compared with 25% nationally). The number
of children and young people (aged 15 and below) in Solihull is, at 19%, in-line with the England
average, although it is notable the borough has a relatively low proportion of pre-school age
children; those aged 0-4 years represent 29% of all children in Solihull compared to 34% nationally.
Solihull wards can be divided into three broad geographic areas:
Urban West
Regeneration
Semi-Rural South and East
Castle Bromwich, Lyndon, Elmdon, Olton, Silhill, St Alphege, Shirley
East, Shirley West and Shirley South
Chelmsley Wood, Kingshurst & Fordbridge and Smith’s Wood
Blythe, Bickenhill, Knowle, Dorridge & Hockley Heath and Meriden
These three geographic areas have significantly different age profiles, with a younger population in
the North Solihull regeneration wards a notable feature; 23% of the population in the North are
aged 15 or under with a further 21% aged between 16 and 29. By contrast, one in five of the
population in the urban west is of retirement age, with nearly half aged 45 or over (48%), which is
similar to the profile in the semi-rural South and East.
4
Populaation Projjections The overall Solihull population is projected to increase by 11% to 229,500 betw
ween 2010 and 2030. Populatiion increasess are projectted to be subbstantially grreater among older age ggroups. By 2
2030 it is projecteed that theree will be aro
ound 53,500 people in Solihull aged 65 and overr equating to
o 23% of the totaal population
n, with those
e aged 85+ m
more than do
oubling to 10
0,500. In prooportional te
erms the 85+ agee group will increase from 2.5% oof the total Solihull po
opulation to o 4.6%. The
e ageing populatiion has impllications for the provisioon of health and social ccare as well as the supp
port ratio (the pro
oportion of w
working aged
d to retired ppeople). The age band 2
20 to 65, froom which the bulk of the worrking age population p
will w be draw
wn (regardle
ess of changes to the school leavving and retiremeent age), is p
projected to increase in SSolihull by le
ess than 3% by 2033. Thhis is less tha
an a third of the raate for the o
overall population and iss part of a lo
ong term pro
oportional ddecline in the
e pool of economically active population a
at a local, reggional and national level. Migrattion Populatiion migratio
on patterns a
are part of SSolihull’s chaanging demo
ographic proffile, with ne
et inward migratio
on contributiing to the bo
orough’s groowing populaation. Between 2001/022 and 2008//09 there has beeen an averagge annual ne
et inward m
migration of 58 per 1,000 populationn. This includes net increasees in the num
mbers of young familiess (significanttly from Birm
mingham) offfset by net outflows among yyoung adultts (moving to set up or home in lower cost areas or studyy) and more
e mature families aged 45‐64 years (often where childdren have lefft home) and retirees. Within SSolihull, Blyth
he, driven byy the develoopment of Dickens Heath
h, the North SSolihull rege
eneration wards aand Olton haave recorded the higheest levels of population turnover (innflow plus outflow). o
Although with high levels of pe
eople leavingg the area as well as mo
oving in the Regeneratio
on wards have seeen the highest levels of n
net outward migration. 5 A key feeature of dem
mographic ch
hange acrosss the UK in re
ecent years has been an increase in overseas onally betweeen 2002/03
3 and 2010/1
11 the numbber of overse
eas adult nationalls entering the UK. Natio
nationalls registeringg for nationa
al insurance m
more than d
doubled to 70
04,900 with the largest increases coming ffrom EU Acccession counttries, Asia & the Middle East other EU countries. Around 80%
% of new overseas NI registraations in 2010/11 weree under the age of 35, adding sign ificantly to the UK’s naturallyy diminishing working age populatioon. In 2010
0/11 there were w
about 5500 new ove
erseas NI registrattions in Solih
hull, bringingg the cumulaative total to 4,500 since 2002/03. TThis equates to a rate of 35.1 p
per 1,000 wo
orking age po
opulation coompared with
h the national average off 136.3 and tthe West Midland
ds average off 97.8. Amo
ong the Westt Midlands M
Mets, Solihull has the 2ndd lowest rate of new overseas NI registrattions. Ethniccity Solihull is in the midst of a dynam
mic change iin terms of the borough’s ethnic com
mposition, altthough it remainss considerably less ethnically diversse than neigghbouring Birmingham. In mid‐200
09 it was estimateed that there were 21,,800 Black oor Asian Eth
hnic Minoritty (BAME) rresidents in Solihull, equatingg to 10.6% o
of the borou
ugh’s popula tion comparred with 12.5% in Englannd and 14.4
4% of the West Midlands. The number of people in Solihull from
m a BAME grroup increassed by 98% between nd mid‐2009
9, compared with overaall population growth off 3%. The BAME popu
ulation in 2001 an
Solihull is proportio
onally much higher in yoounger age groups, acco
ounting for 15% of all residents r
with 12% of thhose of workking age and 3% of retireement age. aged 15 and under, compared w
At 5.4% of the total borough population Asi an or Asian British residents are the largest ethn
nic group ull, although
h like other ethnic e
groupps (with the exception of o Mixed Racce) the prop
portion is in Solihu
lower th
han the national or reggional averagge. The larggest individual BAME grooups in Soliihull are, Indian (55,000 residents), Pakistani (4,300), B
Black Caribbe
ean (2,500) a
and Mixed Raace, White a
and Black Caribbeaan (1,800). 6 The 2001 Census provides the latest available data for the distribution of the BAME population in Solihull. Generally the greatest proportion of BAME residents live in the Urban West of the borough, with significant concentrations in Silhill (including 12% of the borough’s Asian or British Asian population), Blythe, Shirley East and Olton. The proportions are generally lower in North Solihull, although the three Regeneration wards (Chelmsley Wood, Smith’s Wood and Kingshurst & Fordbridge) do contain 48% of the borough’s Black or Black British population and 41% of the Mixed Race population. The BAME population is significantly lower in the Semi‐Rural wards of Knowle, Meriden and Dorridge & Hockley Heath. Key patterns in the borough include: • Nearly 30% of the 1,500 Black or British Black Caribbean residents of the borough live in Chelmsley Wood or Smith’s Wood; • 70% (1,571) of the BAME population in the regeneration area is either Black Caribbean or Mixed White and Black Caribbean; • Of the 3,650 Asian or Asian British Indian residents, less than 200 live in north Solihull, whereas over 1,750 live in Silhill, St Alphege, Olton, Shirley South and Shirley East; • 91% of those belonging to an Asian or Chinese ethnicity live in the area of Solihull to the south of the A45 Coventry Road and 95% live outside of the Regeneration area. Religion In the 2001 Census 84% of people in Solihull who stated their religion were Christian, with no religion (7%) and Hindu (1%) the next most commonly stated. 78% of the Solihull’s 1,850 Hindu residents live in the Urban West of the borough with the highest concentrations in Shirley East (236), Silhill (210) and St Alphege (205). The borough’s 1,635 Muslim residents are similarly concentrated (75% in the Urban West), although the Sikh population of 1,566 is more widely dispersed through South Solihull with significant communities in Blythe (14% of total Sikh population) and Meriden (6%). Day Time Population Solihull’s population is markedly different during the daytime due to a large influx of workers, pupils and students, shoppers and people using services. The number of employees commuting into Solihull to work in 2001 (85,970) was almost exactly equal to the number of Solihull residents working outside the borough (85,039). There is high inward migration from East Birmingham neighbourhoods on the Solihull border (although there is a significant net outward migration to Birmingham as a whole), as well as significant inward flows from North Warwickshire, North West Warwick, North Stratford and Bromsgrove. The flow from Coventry neighbourhoods bordering Solihull is weaker, possibly reflecting the relative difficulty of travel between Solihull Town Centre (and other strategic assets in the borough) and Coventry; mainline trains run south east from Solihull to Warwick, as does the M40. Solihull has a wide travel to learn area, partly reflecting the strong performance and good reputation of Solihull schools. In January 2011 nearly 6,400 pupils at Solihull maintained primary and state 7 funded secondary schools lived outside of the borough, representing 27% of the secondary school and 13% of the primary school population, compared with the England averages of 8.5% and 3.5% respectively. Birmingham accounts for 85% of the inflow into Solihull secondary schools, Coventry 8%, Warwickshire 4% and Worcestershire 3%. Vulnerable People and Other Demographic Groups The following section covers categories that may be discussed in more detail in other parts of the assessment, which at first hand may appear repetitious. However, the section on Capabilities and Control in particular needs to restate some of this material so that it can be considered in a more specific and standalone health and well‐being context. Physical Disability Physical disability is relatively common; nationally one in ten people are classified as disabled under the Disability Discrimination Act (DDA disabled) while one in twenty of the population have a serious disability, which would equate to around 20,600 and 10,300 people respectively in Solihull. Disability most commonly results from conditions such as arthritis, sensory and hearing impairment; more severe forms of disability result from rarer conditions such as cerebral palsy, multiple sclerosis, Parkinson’s disease or motor neurone disease. Those conditions, and the associated disabilities, that are more prevalent in older people will increase in number as the population increases and ages. Learning Disability Learning Disability (LD) is relatively common affecting 2% of the national population which would equate to approximately 4,100 people in Solihull, while severe learning disabilities are less common affecting around 0.4% of the population (approximately 800 people in Solihull). Condition1 National Prevalence Mild Intellectual Impairment Mild Learning Disabilities (Mild Intellectual Impairment with Additional Problems) Severe Learning Disabilities 2.3% 1‐2% 300‐400 per 100,000 population Estimated Numbers in Solihull 4,740 2,060 – 4,120 620 – 825 The prevalence of Severe Learning Disability is increasing at a national level by just under 1% per year; Severe or Moderate LD is forecast to increase in Solihull by 11% from 2011 (775 aged over 18) to 2030 (858) in Solihull2. This increase is as a result of people living longer, increased survival of children and young people with life threatening conditions, and increased life expectancy of people who have a learning disability. As the general population becomes proportionately older the age 1
Health Care Needs Assessment, Vol 2, 2nd Edition, Stevens, Raftery, Mant and Simpson 2
POPPI ‐ Adult psychiatric morbidity in England, 2007: Results of a household survey, published by the Health and Social Care Information Centre in 2009 8 profile of people with learning disabilities is also changing. Early onset dementia in people with LD is also potentially becoming more common, although this is likely to have a far smaller impact. Mental Health Mental illness is a common condition affecting one in six people at some point during their life. The most common mental health problems in Solihull are neurotic disorders and depression. Large numbers of people in Solihull, over 24,000, are estimated to be suffering from these conditions ‐ this represents 1 in 6 of the population aged 15‐74. These conditions are more common in women and affect all age groups (19.7% of women have a common mental disorder compared with 12.5% of men ‐ recorded rates of depression and anxiety are between one and a half and two times higher for women than for men; rates of deliberate self‐injury are two to three times higher in women than men; women are at greater risk of factors linked to poor mental health, such as child sexual abuse and sexual violence; studies have shown that around half of the women in psychiatric wards have experienced sexual abuse). Mental health conditions are almost three times more common in the wards in the North of Solihull, suggesting an association with deprivation. Around half of people with lifetime mental health problems experience their first symptoms by the age of 14 – it is anticipated that nationally there will be an increase in the number of young people with emotional or behavioural problems. Therefore, by promoting good mental health and intervening early, particularly in the crucial childhood and teenage years, we can help to prevent mental illness from developing and mitigate its effects when it does. It should also be noted that people of Black Caribbean heritage are particularly likely to be subject to compulsory treatment under the Mental Health Act and that South Asian women are less likely to receive timely, appropriate mental health services, even for severe mental health conditions. The following table shows prevalence rates and population estimates for adults aged 15‐74 with common mental health problems: Condition3 Mixed anxiety and depressive disorder Generalised anxiety disorder Depressive episode All phobias Obsessive compulsive disorder Panic disorder Any neurotic disorder Prevalence Rate 8.8% 4.4% 2.6% 1.8% 1.1% 0.7% 16.4% Estimated Numbers in Solihull 13,250 6,630 3,920 2,710 1,660 1,050 24,700 Mental health is a priority area for public health and reducing its impacts could result in significant benefits for the health economy. ‘Tackling poor mental health could reduce our overall disease burden by nearly a quarter’ (Department of Health white paper, Healthy Lives, Healthy People 2011). According to the Solihull Care Trust Mental Health Needs Assessment (April 2011), financially, the costs of mental health problems to the economy in England have recently been estimated at £105 Psychiatric Morbidity Survey 2000
3
9 billion, and treatment costs (currently £11 billion) are expected to double by 2030. Mental health impacts are the biggest cause of disability in the UK and are responsible for 23% of the burden of disease. Furthermore, 11% of the secondary care budget is taken up by mental health and £2 billion is spent on social care. The Foresight (Department for Business Innovation and Skills, 2010) report on mental capital and wellbeing recommended ‘Five ways to wellbeing’ suggested that, in order to fortify mental health, people should: 




Connect – with the people around them, family, friends and neighbours; Be Active – go for a walk or a run, do the gardening, play a game; Take Notice – be curious and aware of the world around them; Keep Learning – learn a new recipe or a new language, set themselves a challenge; Give – do something nice for someone else, volunteer, join a community group. Carers A carer is defined in the Carers (Recognition and Services) Act 1995 as a person who provides a “substantial amount of care on a regular basis”. The 2001 Census indicates that there were nearly 21,000 carers in Solihull equating to 10.5% of the total population, higher than the national average of 9.9%. Given that many people do not recognise themselves as carers (according to research by Carers UK nearly a third of carers do not recognise themselves as such for over 5 years) and that the number of carers is increasing across the country (research by Carers UK estimates a 60% increase in the number of carers by 2037) the actual number of carers in Solihull is almost certainly higher than Census figures suggest. The majority of carers both locally and nationally care for somebody for between 1 and 19 hours per week, although a significant number (3,800 people in Solihull) were committed to over 50 hours a week of care. In terms of local distribution the proportion of people identifying themselves as carers in the 2001 Census were highest in the Urban West and Semi‐Rural South and East of the borough (both 11% of the total population) and lower in the Regeneration area (8.9%). However, the Regeneration area has the highest proportion of people caring for 50 hours or more a week (2.7%). The 2010 Carers User Experience Survey reveals that 31% of respondents spend 100 hours or week or more looking after or helping the person for whom they care, with 49% caring for 35 hours per week or more. The majority of carers from this survey reported that they were retired (58%), with just 9% in full time employment (including self employed) and a further 13% in part time employment (including self employed ‐ 12% were not in paid work) ‐ 40% of carers responding to the survey were aged 65 and over (POPPI predicts that the number of people aged 65 or over in Solihull who provide unpaid care will increase by 30% from 4,609 in 2011 to 5,985 in 2030). Visual and Hearing Impairment In 2011, 79 people in Solihull aged between 18 and 64 are revealed by PANSI to have a serious visual impairment. This is forecast to increase to 82 by 2030. There are similar numbers for those having a profound [communicate by lip‐reading] hearing impairment (46 to 47 over the same time period), although the number of people aged between 18 and 64 having a moderate [difficulty following 10 speech without a hearing aid] or severe hearing impairment is significantly higher (5,115 and 5,229 respectively). Any Hearing Impairment 18‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84 85+ Total Population aged 18+ 2011 24
106
401
1,753
2,875
3,986
8,486
4,816
22,447
2015 23
118
366
1,815
2,819
4,456
8,862
5,706
24,165
2020 2025 22
124
376
1,679
3,175
4,353
9,925
6,508
26,162
21 119 428 1,485 3,370 4,264 11,621 7,666 28,974 2030 23 114 447 1,571 3,122 4,830 11,560 9,358 31,025 When looking at visual impairment for older people moderate problems are also considered, as for those aged 75 and over, approximately half have cataracts or refractive error (ie correctable sight loss). Furthermore, a small proportion have both cataracts and some other registrable cause of vision impairment. It should be noted that age related macular degeneration is the most common cause of registrable sight loss in older people. Visual Impairment 75+ predicted to have a moderate or severe visual impairment 75+ predicted to have registrable eye conditions 2011 2,344
2015 2,542
2020 2,877 2025 3,360 2030 3,584 1,210
1,312
1,485 1,734 1,850 Deprivation The Index of Multiple Deprivation (IMD) combines a number of indicators, chosen to cover a range of economic, social and housing issues, into a single deprivation score for individual neighbourhoods called Super Output Areas (LSOAs) in England. There are 32,482 SOAs in England and 133 in Solihull and the minimum population for a LSOA is 1,000 with an average of 1,500. The Index of Multiple Deprivation therefore allows each neighbourhood (LSOA) to be ranked relative to one another according to their level of deprivation. There are 22 LSOAs in Solihull in the most deprived 20% of neighbourhoods in England of which 15 are in the bottom 10% and 2 in the bottom 5%. Compared with 2007 there are more Solihull LSOAs in the bottom 10% nationally (15 versus 10) and there are now two LSOAs in the bottom 5% compared to none in 2007. All of the LSOAs in the bottom 10% in 2010 are in the Regeneration area, the most deprived forming a contiguous cluster comprising Cole Valley and Chelmsley Wood Town Centre. Hobs Moat North (Lyndon) is the most deprived LSOA outside of the Regeneration area, with Olton South, Ulverley East (Lyndon), Green Hill (Shirley East) and Parkfields (Castle Bromwich) also in the most deprived 30% in the country. 11 Overall IMD Alcott Hall
Hobs Moat North
North Arran Way
Chelmslsey Wood Town Centre
Craig Croft
Percentile
0 - 5th (Bottom 5%)
5 - 10th
10 - 20th
20 - 30th
30 - 50th
50 - 75th
75 - 90th
90 - 100th (Top 10%)
Source: Index of Multiple Deprivation 2010
Further analysis of deprivation in Solihull, its link to the anti‐poverty agenda and health can be found in chapter Ensure a Healthy Standard of Living For All. The Living Environment The living environment, with a mix of urban and rural communities, key strategic sites and transport infrastructure, and large amounts of green space, is one of Solihull’s key strengths, as evidenced by high levels of resident satisfaction with the area ‐ 90% of respondents to the 2011 Solihull Place Survey said they were satisfied with their local neighbourhood as a place to live, ranging from 100% in Blythe, Shirley South and St Alphege to 67% in Smith’s Wood. The main divide is between respondents from the Regeneration wards, where 74% said they were satisfied and the rest of the borough (93%). 12 The livin
ng environm
ment in Solihull is consid ered in morre depth in the t chapter Create and Develop Healthy and Sustainaable Places a
and Communnities. Urban/Rural Claassificatio
on Over 900% of Solihull residents live in an urbban area, with a further 6% in a tow
wn or fringe location, compareed with 84%
% and 6% re
espectively iin the Westt Midlands. Proportionaally fewer people p
in Solihull live in smalleer village or hamlet settllements (3.6
6%) than the regional aveerage (9.8%)). In part this reflects the higgh proportion of Solihul l’s rural area which is designated d
aas Green Be
elt where development is restricted. The Bu
uilt Enviro
onment an
nd Infrast ructure ‐ Housing P
Provision aand the Housin
ng Markett Solihull provides an attractive residential ennvironment and this cre
eates a high level of dem
mand for emand is refflected in higgher than avverage housee prices com
mpared to housing in the borough. This de
egistered the restt of the Wesst Midlands,, significant numbers off householdss on the Couuncil and Re
Social Laandlord (RSL) housing wa
aiting lists annd no ‘difficu
ult to let’ problems. There w
were an estim
mated 80,930
0 householdds in Solihull at the 2001 Census, inccreasing to 8
87,948 by 2009 (H
Housing Strattegy Statistical Appendiix). Single households h
account for 26% of the
e total in Solihull, compared w
with 29% in the West M
Midlands and
d 30% in Eng
gland. Accorrding to the ONS the olds in Solih
hull is projeccted to reacch 100,000 by 2026 wi th sharp an
nd above number of househo
n the numbe
er of househoolds aged ovver 70 and 8
85 (which willl represent 24% and average increases in
n 2026). Thee other signifficant shift iss in the num
mber of single person 5.3% resspectively off the total in
househo
olds, with tw
wo thirds of the growth u p to 2026 re
esulting from people livinng alone. Housingg related issu
ues are conssidered in m
more depth in the chapte
er Ensure a Healthy Standard of Living Fo
or All. 13 Potential Challenges for Consideration The Regeneration area has been more affected by the recession due in part to the following factors: 


Nature of employment and low skills profile Access to suitable jobs and reliance on public transport Younger less well educated population Will falling household incomes affect nutrition, which is already a concern Will on‐going economic problems which are affecting regeneration lead to more people being at risk of mental health problems and make it harder to help those already at risk Will entrenched youth unemployment lead to more problems with addiction and related problems further affecting quality of life in the area The private rental housing sector in particular, throughout less affluent parts of the borough, is anticipated to accommodate an increasing number of families either in or at risk of poverty (being disproportionately affected by rising energy prices). Will the health of a greater proportion of children be affected by cold and damp housing conditions An ageing population places demands on health and social care which will inevitably have an impact on the funding of other services. At the same time there are implications for planning: 


More housing that is suitable for older people Better access to key services Improved energy efficiency of the existing privately occupied housing stock Will the capacity for health interventions and ill‐health prevention be affected across the whole population What are the implications for the health of the increasing number of older carers The population of Solihull is forecast to grow with significant demographic changes: 


People are living longer often with long‐term health conditions Household structures are changing (more single person households and potentially more overcrowding) In‐migration and rapidly growing BAME communities (requiring culturally sensitive services) This will require more housing that will be of a higher density Will residents of Solihull be affected by increasing environmental problems (congestion/pollution, noise and greater impact from climate change) Will there be a subsequent increasing incidence of stress and depression 14 GiveEveryChildtheBestStartInLife
Key Findings •
Low birth weight is a good indicator of the current and future health of the baby: the Solihull rate (7.6%) is lower than the national average but reaches 11% in at least 1 ward; •
Smoking at time of delivery has increased over the last few years; is high when benchmarked against similar populations and in the more deprived wards; •
Caesarean section rates remain high and compare unfavourably when benchmarked against similar populations; •
Breast feeding protects the health of mother and baby but is comparatively low in Solihull; however rates have improved over the last 2 years and the gap between north and south has narrowed; •
There is scope for the uptake of immunisation to be improved; •
Early years development is ranked 2/152 LAs with 69% of children achieving good levels of development (Foundation Stage Profile); there is a 30% gap in achievement across Solihull although there has been significant improvement in some areas; •
Good uptake of childcare by low income families – 18% uptake of working tax credit (23%) and good access to childcare; •
Children with disabilities, Looked After Children, children subject to a child protection plan and children living in poverty have greater level of needs. Introduction Breaking the link between early disadvantage and poor outcomes in later life can only be achieved by ensuring that all children receive the best possible start in life. Reducing inequalities across maternal and infant health as well as early years’ education and development are among the key factors in this overall objective. Overall, the key indicators of infant and early years’ health are relatively positive in Solihull. The proportion of women receiving an antenatal assessment by 12 weeks at the 4th Quarter 2010 is 90.7% compared with 84.2% for England. Women who are able to access maternity services for a full health and social care assessment of needs, risks and choices by 12 completed weeks of their pregnancy will have the full benefit of personalised maternity care and improve outcomes and experience for mother and baby. Improving access to maternity care will improve outcomes for mothers and babies by providing opportunities for women to make informed choices and shared decisions about their maternity care, including where and how they give birth. 15 However, other measures are less positive, with evidence of local inequalities across the indicators of early years’ health and ongoing challenges around some contributory factors such as smoking at time of pregnancy and breast feeding. Families and Parenting The Solihull Model for Multi Agency Support of Children, Young People and Their Families, known as LINCS (Local Integrated Needs‐led Coordinated Support), provides an important tool to support early intervention and multi‐agency working. The Model includes an agreed framework of need (rising taxonomy) and risk known as the ‘Positive Outcomes Model’. The nature of the Model suggests that some children’s level of need may change whilst others may remain complex (at Level 3), due to multiple, long‐term needs. This creates a structure for agencies to work together, reducing the negative impact of agencies working in isolation, through a Keyworker and Lead Professional system where families are involved in identifying their own strengths, networks of support and additional services that they might need. The ‘Positive Outcomes Model’ is summarised in the following table which also incorporates guidance from the Hardiker Model of Parenting: 1 Universal Needs Children and families who utilise universal services and community services as required, and may require occasional advice, support and/or information. 2 Additional Needs Vulnerable children who may be at risk of social exclusion – enhanced services may be required to minimise risk‐taking behaviours. 3 Complex Needs Children with complex needs that may be chronic and enduring – includes children with a disability – health and development may be significantly impaired without the provision of services. 4 Acute Needs Children who are suffering, or likely to suffer, significant harm without the provision of services. For some this cannot be resolved within the family and so, some children will be in need of rehabilitation. The focus for Level 1 is largely for health promotion and protection within universal settings such as GPs, schools and popular clubs/societies (extended family networks and friends are also known to be important conduits for information and advice). The efficacy of this can be evidenced by health appointments being kept, immunisation being up to date and children receiving regular dental and eye care. Wider evidence from schools and early years providers can be sought from absences being explained, learning being on track, children being well behaved and displaying independent living skills. This is by far the largest group within Solihull and so it is vitally important to continue monitoring related outcomes (this could include a particular focus on traveller families). Paradoxically, families in the Regeneration wards of North Solihull in particular, being the most disadvantaged, are the least likely to benefit from universal services whilst having the greatest need. Effectively persuading parents in this area to become or remain engaged with universal services that can bring real and lasting benefits to their children is the first step in addressing the problems that currently manifest in a far higher prevalence of more intense needs. 16 The following table illustrates some of the concerns that might be a trigger for the relevant ‘specialist’ interventions (it must be noted that this is a cumulative schema as concerns raised at lower levels can persist and become more severe, also as soon as significant harm is suspected any case will be referred immediately to Level 4): Additional Needs (2) – minor health problems, not registered with GP/Dentist, A&E attendance giving cause for concern, parent not accessing post/antenatal care, large number of pre‐school children, child is a carer, parent has numeracy/literacy/communication problems, low level substance misuse, truancy, bullying, provocative behaviour, petty crime, poor hygiene, some exposure to dangerous situations, loss of significant adult, frequent change of address, refugee/asylum seeking Complex Needs (3) – inappropriate sexual activity, hostile behaviour, deteriorating parental relationship, multiple carers, parental instability, child regularly left alone or unsupervised, overcrowded housing, serious debt Acute Needs (4) – self harming or suicide attempts linked to periods of depression, offending behaviour, regularly going missing, excluded from school, persistent serious domestic violence, parents involved in crime, serious housing hazards Single Agency Referral Family Support Plan Common Assessment Framework Multi‐Agency Family Support Plan Core Assessment Multi‐Agency Plan Statutory Action/Immediate Action Awareness of and intervention for Level 2 families are likely to include those enhanced services delivered by voluntary organisations through children’s centres (such as father’s involvement). Therefore, referrals from Education Psychologists and Health Visitors for instance are vital along with feedback and evaluation of the intervention for commissioners. However, it is important to note that while earlier intervention is effective, the effects should also be sustained over time through age‐appropriate support. While early intervention does help to significantly reduce risk, it is not an "inoculation" against the development of later problems. It would appear therefore that a continuum of support from universal provision through to specialist targeted provision most effectively meets the needs of children and families at different ages and stages across the life course (typically infant, middle years and teenagers). A variety of different services and interventions are required to address the often very different needs of families and the multiple risk factors that impact on children's outcomes. Level 3 includes children with a disability as well as safeguarding, typically comprising community based services – by Level 4 the need for joined‐up multi‐agency approaches, perhaps having a dedicated coordinator, becomes increasingly necessary to ensure that the added complexity of multi‐agency support is managed efficiently, while also providing a clear point of contact for parents and carers. Families with multiple service needs (such as health, mental health, education and employment services) can benefit from having these services offered in one location. Not only is it more convenient, it can also ensure that the services are properly linked and that information is shared between services. This can also reduce some of the stigma and difficulty that parents face in pursuing various and multiple types of support. There are also important links here with the Families featuring Multiple Problems (FMP) programme. The JSNA will provide a general narrative around many of the above factors with more in depth forensic investigation anticipated for the next refresh (due from September 2012). Further 17 ng Children and Young People’s Outcomes O
understaanding may also be gained from tthe upcomin
Review. Early Y
Years and School Re
eadiness
Research shows that investing in
n the early yyears and im
mproving a ch
hild’s readineess for school is vital on Stage Proofile is excelllent with for laterr educationaal outcomes.. In this resppect Solihull’’s Foundatio
69% of children ach
hieving a goo
od level of ddevelopmentt, ranking the Borough 22nd out of 1
152 Local Authoritties in the co
ountry (56% a
across Engla nd as a whole). The Earlly Years Foun
ndation Stagge Profile (FSSP) is an on‐ggoing assessm
ment consistting of 13 scales with ble score of 9 for each area (maxim
mum score available a
117
7). These sccales cover personal, p
a possib
social an
nd emotionaal developme
ent, commu nication langguage & literacy, probleem solving, reasoning and num
meracy, kno
owledge and
d understandding of the world, physical develoopment and creative development. Furth
hermore, the
e proportionn of children
n achieving a good leveel of develop
pment in Solihull has trended upwards fro
om 64% in 20006‐07 to the
e 69% curren
ntly. Data fro
om 2008/09 shows that there are siggnificant varriations with
hin the Boro ugh, with a 30% gap between
n the achievvement of th
he lowest‐acchieving 20%
% of children
n in Solihull and the rest of the cohort aand while thee gap is narrrowing it rem
mains higher than the tarrget of 23.8%
% set by the previous Governm
ment. Howevver, there ha
as been proggress over recent years, w
with, for insttance, the prroportion of childrren in Fordbrridge achieving a good leevel of devellopment incrreasing from
m 24% in 2006 to 64% in 2010 and a similar increase fro
om 21% to 552% in Smith’s Wood. 18 Evidence from research on the most important factors influencing educational attainment suggests it is families, not services that have the most influence, so support for families in the early years, and at key transition points is crucial. The local 2011 Ask Parents survey reported that 57% of parents say they have enough support in their parenting role, 53% say they can find the information they need and 26% feel they can influence decisions about services for their family. Provision of high quality childcare has a critical influence on educational attainment and early year’s development. The Childcare Sufficiency Assessment (2010) suggests that, overall, there is sufficient childcare in the Borough and that the formal take‐up of childcare by low income families is improving and among the highest in the country. However, over a quarter of parents surveyed for the Assessment indicated that available childcare didn’t meet their needs with respondents citing cost, the need for childcare to be more flexible to meet shift patterns and a lack of suitable places in terms of quality, distance and age range (especially for parents of children with a disability) as the main barriers to take up. Formal take‐up of childcare by low income families is measured through the childcare element of the working tax credit. HMRC data for 2008/09 shows that 1,680 families in Solihull benefited from help with childcare costs using the childcare element of the working tax credit, equating to 23% of all families, compared to about 18% for England as a whole, ranking the Borough 12th out of 150 Local Authorities on this measure. Solihull has seen year increases in the take‐up of working tax credit, with proportions higher than England in each year since 2004/05. Fertility In 2008, there were an estimated 39,200 women of childbearing age (15‐44 years) residing in Solihull PCT, accounting for 19% of the total population. This number is due to decrease to 37,100 across Solihull PCT by 2020. Official figures released by the Office for National Statistics show a steady increase in the number of births occurring each year locally, with 2,172 live births registered to Solihull PCT resident mothers in 2008 (up from 2,110 in 2006). The general fertility rate for Solihull PCT is currently less than that of England at 55.6 per 1,000 women aged 15‐44 years (or 1.8 per woman [stable] compared with 1.97 in England at 2008 up from 1.82 in 2006). Most deliveries in Solihull PCT for 2009‐10 were spontaneous vertex (61.5%). Emergency caesarean sections accounted for 15.3% of births and 12.7% were elective caesarean sections (well ahead of the England level of 24.1). Teenage pregnancy is strongly associated with the most deprived and socially excluded young people. Difficulties in young people’s lives such as poor family relationships, low self‐esteem and unhappiness at school also put them at greater risk of teenage pregnancy. Evidence clearly shows that having children at a young age can damage young women’s health and well‐being (teenage mothers suffer a 30% greater risk of mental ill health within two years of the child's birth) and severely limit their education and career prospects. Longitudinal studies show that children born to teenagers are more likely to experience a range of negative outcomes in later life, and are up to three times more likely to become a teenage parent themselves. For 2006‐08 the rate in Solihull is 36.0 per 1,000 females aged 15‐17 considerably lower than the England (41.0) and West Midlands 19 (46.2) levels. More detail is provided within the Sexual Health section (also of note is that the prevalence of chlamydia in those under 25 is effectively top quartile – 4.8% compared with 6.0% in England). Mortality Infant mortality rates refer to the number of deaths within the first year of life per 1,000 live births. Wide variations in rates are often seen annually due to small numbers of events. Therefore three‐
year rolling averages are used to even out variation. Infant deaths are not common events, particularly in Solihull where the rate is just 4.8 per 1,000 live births (or count of 31) between 2007 and 2009 – lower than the West Midlands (6.2) and broadly in line with England as a whole (4.7). Across all children and young people (aged from 1 to 17) the long‐term mortality rate from 2001 to 2009 directly standardised at 13.7 per 100,000 population is effectively in the top quartile (12th percentile) compared with all authorities in England (overall 16.9 – West Midlands 17.7). Although unrelated the hospital admission rate from 2006‐09 for those under 18 due to injury is also effectively top quartile (10th percentile) ‐ Solihull is 1,119.3 per 100,000 compared with 1,443.2 for England. However, this is not reflected in emergency admissions for 2009‐10 which is firmly within the second quartile. Smoking and Excess Alcohol in Maternity Smoking during pregnancy causes distress and damage to the unborn baby. Health risks to babies due to maternal smoking include: Lower birth weight and weakness; Slower growth for the baby; Higher chance of cot death; Damage to airways which could cause breathing problems or asthma. There are also ongoing health risks of children growing up in smoking households from: Respiratory infections; Asthma; Lung cancer when they are adults; Meningitis; 'Glue ear' and partial deafness. Smoking during pregnancy has not reduced significantly for Solihull mothers from 15.6% at 2006‐07 to 15.5% for the 4th Quarter 2010 and is higher than the average for the Prospering Smaller Town peer group and England as a whole (13.3%). The following chart shows the trend in the proportion of women smoking at the time of delivery for Solihull PCT (NHS Health and Social Care Information Centre). 20 map below shows s
a high
her proporti on of mothe
ers in the North Solihulll regeneratio
on wards As the m
smoke d
during pregn
nancy than in i the rest oof Solihull, although a
pockets of hig her prevalen
nce exist elsewheere. Low Birth Weight Low birtth weight is closely asso
ociated withh foetal and neonatal mortality and morbidity, inhibited growth and cognitivve developm
ment, and chhronic diseasses (risk of coronary c
heaart disease, diabetes pertension) later l
in life. A baby’s loow weight at birth is eitther the ressult of prete
erm birth and hyp
(before 37 weeks of f gestation) o
or due to resttricted foetaal (intrauterin
ne) growth. Low birth we
eight has been deefined by thee World Health Organizaation (WHO) as weight at birth of lesss than 2,50
00 grams. Very low
w birth weigh
ht is defined as weight att birth less th
han 1,500 grams. Birth weeight is affeccted to a great extent by y the motherr’s own foeta
al growth an d her diet frrom birth to pregn
nancy, and thus t
her bod
dy composit ion at conce
eption. Moth
hers in deprrived socio‐e
economic conditio
ons frequently have low birth weightt infants. In those settin
ngs, the infannt’s low birth weight stems primarily from
m the mothe
er’s poor nuutrition and health over a long periood of time, including i
during p
pregnancy, the t high pre
evalence of specific and non‐specific infections,, or from prregnancy complicaations, undeerpinned by p
poverty. Data fro
om the Pub
blic Health Births B
File shhows that on o average 7.6% of babbies born in
n Solihull between
n April 2006 and March 2009 [6.4% iin 2009] had
d a low birth weight, in‐liine with the national average, but above that for the Prosperingg Smaller To
owns peer group g
(6.5%)). The North
h Solihull w birth weig
ght babies t han the resst of the Regenerration wardss have a higgher prevaleence of low
21 Borough, with the highest rate in Chelmsley Wood (11.1%), although the link to deprivation is fairly weak. Data looking at multiple births over time in Solihull PCT shows that the number of multiple births was 3.2% of all live births in the past three years. Babies from multiple births are often born prematurely and are small for their gestational age. A twin is six times more likely to die before birth or during the first year than a singleton. Analysis of Solihull PCT resident women giving birth in the financial year 2009‐10 by age shows that the highest proportion of births were to women aged 30‐34 (28.8%). The chart below shows mothers' ages at the time of giving birth in five year aged bands (ONS). Research from Neighbourhood Knowledge Management to identify the factors which are associated with low birth weights in Doncaster (7.4% low birth weight, in line with Solihull) revealed that the risks of having a low birth weight baby increased by 37% of the mother lives in social housing and by 13% if there were 3 or more children in the household – when these factors are combined the risks increased by 46%. It is not known whether this applies to Solihull but the implication is that this could be used to target at‐risk groups, providing them with better access to ante‐natal care and support through pregnancy. Further research in Birmingham reveals a similar picture with those most at risk of low birth weight being non‐white teenage mothers living in households on benefits (when these two factors occur together the risk of having low birth weight increases by 96%). Screening and Immunisation Immunisation protects children against a range of serious illnesses. The immunisation rate of infants resident in Solihull before their 1st birthday is better than the England average for all applicable immunisations and is in the mid range for Prospering Smaller Towns. This positive level of take‐up is maintained, with generally high levels of take‐up of immunisations up to children’s 5th birthdays. Notably, the take‐up of MMR is relatively high at GP Practices across the Borough, demonstrating that preventative services can be effective in more deprived populations. Protection is also provided for older children, for instance the Human Papilloma Virus (HPV) which is one of the most common sexually transmitted infections and the main cause of cervical cancer. The Department of Health introduced the HPV vaccine for girls aged 12 to 13 years followed by a phased catch up programme in 2008 with the aim of reducing the incidence of cervical cancer. Uptake of 22 V vaccine in SSolihull in 2010 was 94.9%
% (1 dose), 8
86% (2 dosess) and 74.2%
% (all three doses). All the HPV
three figgures were above the reggional and naational averaage (the firstt two significcantly). The follo
owing table h
highlights the key indicattors for Solih
hull (2010‐11
1) compared with England: Com
mpleted MM
MR immunisation coursee by 2nd birtthday (%) Com
mpleted Dip
phtheria, Tettanus, Polio, Pertussis, H
Hib imm
munisation ccourse by 2n
nd birthday ((%) Com
mpleted Me
enC immunissation coursee by 2nd birtthday (%) Com
mpleted Dip
phtheria, Tettanus, Polio, Pertussis, H
Hib imm
munisation ccourse by 1sst birthday (%
%) Com
mpleted Me
enC immunissation coursee by 1st birth
hday (%) Com
mpleted Pne
eumococcal conjugate vaaccine by 1sst birthday (%
%) Solihuull 88..9 98..0 Englan
nd 89.1 8
96.0 9
98..5 95..4 94.8 9
94.2 9
95..2 95..3 93.4 9
93.6 9
It is nottable that Solihull is only below th e England average a
for MMR immuunisation and is well behind tthe West Midlands level of 91.5%. M
Measles is a serious but preventable disease being highly infectiou
us, transmittted via dro
oplet infecti on. Almost all who arre infected develop symptoms. Measless is usually aa childhood iinfection. It is most com
mmon in 1‐4‐year‐old ch ildren who have not been im
mmunised. Complication
C
ns occur in approximate
ely 30% of reported caases, includiing otitis media, b
bronchitis, pneumonia, cconvulsions, blindness an
nd encephalitis. The inciddence of enccephalitis is aroun
nd 1 in 1000
0 cases, and it has a moortality of arround 15%. The T availabl e measles vaccine v
is highly eeffective, given as part of o the MMR immunisation with a first dose at 12‐15 months and a second dose at 4‐5
5 years. The
e WHO recoommends im
mmunity levvels of arouund 95% to prevent outbreaks of diseasse. A single dose of MM
MR protects over 90% of o children w
who receive it, but a uired to ensure sufficiennt protection
n to preventt outbreaks of the disea
ase. The second dose is requ
following demonstraates that high take up ca n be achieve
ed in deprive
ed areas. 23 Breast Feeding A large body of published research has shown that breast feeding has clear health benefits for both mothers and infants. Breast fed babies are less likely to suffer from conditions such as gastroenteritis, chest, urinary tract, or ear infections, diabetes in childhood, and childhood obesity. For some of these conditions the longer the duration a baby is breasted the greater the protection gained or the more positive the impact on longer‐term health. Mothers who breast feed have a reduced risk in later life of some cancers (ovarian and breast) and of osteoporosis. The current recommendations on feeding infants are: • Breast milk is the best form of nutrition for infants • Exclusive breast feeding is recommended for the first six months (26 weeks) of an infant’s life • Six months is the recommended age for the introduction of solid foods for infants • Breast feeding (and/or breast milk substitutes) should continue beyond the first six months, along with appropriate types and amounts of solid foods. Breast feeding protects the health of mother and baby but is comparatively low in the UK, especially among disadvantaged groups. Within this context, breast feeding initiation rates in Solihull are improving (from 61.9% at 1st Quarter 2009 to 71.2% at 4th Quarter 2010 [England 73.4%] – 29.4% were totally breast fed) but are still below both the national average (effectively bottom quartile) and the Prospering Smaller Towns peer group (Department of Health, Public Health Statistics). 80
70
60
50
40
30
20
10
Q1 2011
Q4 2010
Q3 2010
Q2 2010
Q1 2010
Q4 2009
Q3 2009
Q2 2009
Q1 2009
0
Locally breast feeding initiation (6 to 8 weeks) is lower in the North Solihull Regeneration wards than the rest of the Borough, although the gap appears to have narrowed between 2007‐08 and 2008‐09. There is clear evidence that adequate support to breast feeding mothers in the first few weeks is likely to increase the duration of breast feeding. 24 Childreen’s Disab
bility Children
n with long‐‐term disability are a ddiverse grou
up. Some will w have higghly comple
ex needs requiring multi‐agen
ncy support across hea lth, social services and education –– the most extreme e who are technologyy‐dependentt. Other chhildren will require examplee perhaps being those
substanttially less support, althou
ugh nevertheeless have a long‐term d
disability. Thhere have be
een many attemptts to providee accurate estimates e
of disability in children an
nd young peeople. Some of these have pro
ovided cond
dition based estimates bbased on the
e literature and a others hhave utilised
d specific survey d
data. Inform
mation on self‐reported
s
d (by the parent) long‐‐standing ill ness or disability is provided
d from the G
General Houssehold Surveey. Routine data is colllected by local authorit ies on children with sta
atements off Special Edu
ucational Needs, but this doees not reflecct the spectrrum of disab
bility and is only a weakk proxy mea
asure for severity. There is on
ngoing work to define dissability in the context off the child’s pparticipation
n in usual were to be adopted activities, using questionnaires to familiess and childrren. If this approach w
nationallly (for local implementation) then meaningful comparison
ns could starrt to be made. The Departm
ment for Children's, Schools and Fam ilies (DCSF) h
has stated th
hat: ‐ Disabled child
dren and young people cuurrently face multiple m
barrie
ers which maake it more diifficult for them to achieeve their potential and to aachieve the outcomes their p
peers expect. ‐ 29% of disablled children na
ationally live iin poverty. ‐ The educatio
onal attainme
ent of disableed children iss unacceptablly lower thann that of non
n‐disabled children and ffewer than 50
0% of schools have accessib
bility plans. ‐ Disabled young people ag
ged 16‐24 aree less satisfied
d with their liives than theiir peers and there is a all away at keey transition p
points as young people moove from child
d to adult tendency for support to fa
services. 25 ‐ Families with disabled child
dren report paarticularly hig
gh levels of unmet needs, isoolation and sttress. ‐ d
childrren are suppoorted by socia
al services. A report by thee Audit Comm
mission in Only 4% of disabled 2003 found tthat there wa
as a lottery off provision, inadequate stra
ategic planninng, confusing eligibility criteria, and tthat families w
were subject tto long waits a
and had to jum
mp through hooops to get su
upport. ‐ The prevalencce of severe d
disability is inccreasing. The follo
owing table p
provides the
e estimated nnumbers of cchildren with
h a disability as at 2008 (Departm
ment for Edu
ucation): Age 0‐4 5‐9 10‐14 15‐19 Total Mild
d Disability
M
Male Female 658 572
1,525 1,026
1,400 1,273
1,314 1,104
4,897 3,975
All 1,230
0
2,551
1
2,673
3
2,418
8
8,872
2
Disability Severe D
Male
Fem
male 705
7
352 732
7
285 560
5
268 219
2
138 2,2
216
1,043 All 1,057
1,017
828
357
3,259
The prevvalence ratees of children
n and adolesscents with mild disabilitties were foound to be higher for those fro
om semi‐skillled manual and unskilledd manual fam
mily backgro
ounds. The prrevalence off children with milld disabilities from profe
essional fam
mily backgrou
unds were lo
ower in com parison to the other socio‐ecconomic grou
ups. The rate
e of severe ddisability wass found to be
e greatest am
mongst children from semi‐skiilled manual family backgrounds, whhilst the lowe
est rates were for childreen from professional mily backgrou
unds. The h
health and disability d
domain score ffrom the 20
009 Child and managerial fam
th
Well‐beiing Index plaaces Solihull in the top qquartile (24 percentile) which comppares favoura
ably with th
the overrall index 47
7 percentile
e. This sugggests that he
ealth outcom
mes are not in line with material deprivattion and povverty in Solih
hull and so applying nattional prevalence rates might over estimate the num
mbers of child
dren affected
d. The oveerall rate forr Solihull fun
nded pupils with Speciaal Educational Needs ass at Octoberr 2010 is approxim
mately 29.5 per 1,000 agged 5‐19. Thhe top 6 prim
mary need categories acccount for ove
er 90% of pupils w
with SEN (locaal transactional data). Research has suggessted that mo
oderate learnning disabilitties are corre
elated with ddeprivation, whereas pears to be the case in
n Solihull (a
analysing Staatements off Special autism may not bee. This app
26 onal Needs [SEN] [
and ch
hildren’s dis ability servicces at the Meadow M
Cenntre) where although Educatio
realised autism show
ws no geogrraphical patttern compared with refe
errals [worthhy of note th
hat there are reco
ognised gaps in local provvision], mod erate learnin
ng difficulties in particulaar correlatess strongly with dep
privation locally (Index of Multiple Deeprivation).
The reseearch also su
uggests how gender is re lated with au
utism, which
h can again bbe seen in So
olihull – it is worth
h noting thatt behaviour, emotional aand social diifficulties are
e most prevaalent in males and is also corrrelated with deprivation. 100%
90%
80%
0.6
70%
60%
6.2
2
11.2
6
6.9
42.8
4.4
0.3
3.2
0.6
7.7
1.8
0.1
1.7
0.3
4.8
1.1
50%
40%
30%
20%
10%
1.1
2.4
1
1.8
15.7
1.8
0.6
Male
Female
0%
rate per 1,000
0 population
The follo
owing maps show the rate per 1,0000 children for those with Behaviour, Emotional and Social Difficulties (highest male prevalence of all SSEN types – only Hearing Impairmennt shows a p
parity) or Moderate Learning D
Difficulties (b
both more li kely to be picked up with
h increasing age). 27 Although analysis frrom the Dep
partment forr Education (DfE) and re
esearch by EEmerson and
d Hatton (2004) ssuggests a link between the prevaleence of proffound/severe
e learning ddisabilities an
nd South Asian po
opulations, this t
is not noticeable n
w
within Solihulll currently which w
may bbe a combin
nation of relatively small num
mbers (particu
ularly when ffactoring in incidence off learning dissability in the
e general p
tly within the more populatiion) and that the Soutth Asian poppulation of Solihull is predominant
affluent areas and so s may not correspond with national research. However, tthere are po
otentially culturallly sensitive issues arou
und unmet need which when combined witth anticipate
ed rapid populatiion change, particularly in small areeas might re
equire a conssideration off this area in service related eequality imp
pact assessments. The follo
owing chart reveals that some Speciaal Educationaal Needs are more likely to be picked
d up with increasin
ng age (the larger categgories exceppt for severe
e learning difficulties), w
whereas som
me of the other caategories sugggest that there might be increased
d rates within the popuulation but again a
the numbers are so smaall that no me
eaningful connclusions should be derivved from thiis. 28 Childh
hood Obessity Among tthe greatest challenges iin respect off childhood h
health is the increasing pprevalence o
of obesity both naationally and
d over recen
nt years in Solihull. It should be noted n
for 20010‐11 that at both Receptio
on year (7.7
7% ‐ effectivvely top quaartile) and year y
six (16.0%) the prooportion of children classified
d as obese in
n Solihull is b
below both tthe England (9.4‐19.0%) and West M
Midlands (10.1‐20.6%) average (NHS Inform
mation Centrre). When coombined witth children w
who are overrweight, the position hull is still beetter than En
ngland and W
West Midlan
nds at both rreception annd most nota
able year for Solih
six (again 2010‐11): Overweigght & Obese (%) Solihull England West Mid
dlands Rece
eption 21.4
4 22.6
6 23.6
6 Ye
ear Six 27
7.0 33
3.4 35
5.2 This is consistent wiith evidence of school suurveys which
h indicate tha
at Solihull puupils are sign
nificantly ort regularly eating freshh fruit and vegetables v
than t
the nattional average. It is more likkely to repo
notable that since 2007‐08 the p
proportion oof obese child
dren in the R
Reception yeear has actua
ally fallen ull from 8.5%
% to 7.7%, d
despite an inncrease at ye
ear six (from 14.1% to 1 6.0% ‐ thouggh might in Solihu
have peaked). How
wever, there a
are also locaal inequalitie
es evident in childhood oobesity at year six. At he north Sol ihull regeneration wards (19.1%) thhan elsewhere in the this age the rate is higher in th
h (14.8%). Borough
There arre potentiallly also conce
erns with thee proportion
n (47.1%) of physically a ctive school children during 22008‐09 bein
ng below tha
at of the Weest Midlands (48.4%) and
d England (499.6%). This measure of the proportion off children gettting at leastt 3 hours of sport or PE p
per week (taaken from the Annual attainment. The HRBQ provides School SSports Surveey) is in starkk contrast too outturns of academic a
some in
nsight into the t differences across tthe borough
h with the following f
chhart highligh
hting the average number of d
days per resp
pondent enggaging in 1 or more hourss of rigorouss exercise. hlighting thosse engaging in rigorous e
exercise for at least 1 hoour, 5 or morre days a The next chart, high
week, reeveals a drop in activity from seniorr school acro
oss genders sset against aa continually growing 29 ween males and female
es (green collumns). Tarrgeting teena
age girls in m
more deprivved areas gap betw
appears auspicious for closing any gap wiith the natio
onal average
e, but theree have alrea
ady been initiativees to these ends and perhaps the underlying causes c
first need to be identified and a then addresseed. Responsses to the 20
010 Health R
Related Behaaviour Questtionnaire (HR
RBQ) carriedd out in most Solihull primary and second
dary schoolss suggest thaat diet patte
erns in adulthood may become esttablished ng that theyy consider heealth when choosing early in life, with a far lower prroportion of pupils statin
what to eat in the North Solihull Regeneratioon wards and
d in some Lyndon and Ollton postcod
des. 30 BQ also tentatively sugge
ests that thee pattern of higher smokking prevaleence in North
h Solihull The HRB
may beggin among children c
and young adullts, with a faar higher ratte stating thhey expect to t smoke when th
hey are olderr than elsewh
here in the B
Borough (thiss will be high
hlighted laterr in the assesssment). Neighbo
ourhood Kno
owledge Man
nagement alsso carried ou
ut research in Doncaster between 20
004‐07 to identify factors signiificantly asso
ociated with childhood obesity in Recception. Thee risks of being obese were 388% higher for boys than for girls andd 34% higherr for children
n in single‐addult househo
olds than for otheer children. However, th
he risks of bbeing obese were 21% lo
ower for chi ldren who had h been breast feed than for tthose who ha
ad not. This appears to rreinforce the
e importancee of breast fe
eeding. Demoggraphic Ch
hange Information regardin
ng the widerr ethnic compposition of SSolihull has already been introduced earlier in T
followin
ng supplemeentary findin
ngs are pressented withh regards to
o specific this assessment. The best start in life: considerration for services related to giving cchildren the b
In total 14.4% of females aged 16‐59 in Sollihull PCT arre from BAM
ME backgrounnds (includin
ng White Other). However 17
7.5% of birth
hs in 2009‐1 0 were to women w
from BAME backkgrounds. In
n Solihull PCT 82.55% of motheers were Wh
hite British. EEthnicity was not reported for 3.7% of mothers and was not know
wn for <1% o
of mothers. Other signifficant ethniciities are Indian (4.2%) annd Pakistani ((2.9%). Excludin
ng English there are at le
east 60 otherr first languaages of Solihull resident pupils within
n Solihull primary and second
dary schools (2011 Schoools Census). Punjabi (19
9.4%), Urdu (18.8%), Ben
ngali and 31 Lyndon
Elmdon
Silhill
Shirley West
Shirley East
Blythe
Olton
St Alphege
Shirley South
Meriden
27
21
19
30
19
30
23
15
13
19
50
32
25
19
31
17
30
13
8
0
48
12
2
5
6
1
13
2
0
0
4
6
2
24
19
6
2
5
14
0
13
4
3
3
5
6
3
10
4
0
3
3
15
2
3
4
0
5
5
0
Tamil
Hindi
Arabic
Gujarati
Bengali
Urdu
Panjabi
Gujarati account for 53.1% of the total, therefore at least 56 other languages account for 46.9% (only Arabic, Chinese, Polish, Hindi, Tamil, Persian/Farsi and French also account for 2% individually). The wards with the greatest concentrations are highlighted below (note the feature areas in Lyndon are to north of Melton Avenue and west of Lyndon Road): 0
5
13
4
1
3
1
3
3
0 Family structures within the UK have changed significantly since the 1960s according to the ONS with lone parent households as a proportion of all households with dependent children rising from just 5.0% in 1961 to an estimated 25.5% in 2010. Extrapolating from the 2001 Census, Solihull might be expected to have 22.5% of households with dependent children headed by a lone parent, although this masks an estimated level of 43.9% in the North Solihull Regeneration wards. There are also other shifts in increased co‐habitation vis‐à‐vis marriage and overall increases in numbers of step families. However, for lone mothers in particular the relative cost of childcare is substantial and alongside subsequent material deprivation are more vulnerable to illness or disability for themselves or their child. Research based on the 2001 Census has found: 17 year olds are most likely to be in education if in married couple non‐stepfamilies; Adults who are married are approximately twice as likely to provide intense care for an ill, disabled or elderly relative or friend as those who are cohabiting. This does not suggest causality for individual families but does provide a pattern when illustrated at a neighbourhood level. This has potential implications for the efficacy of health and well‐being interventions in more deprived areas. Emotional Health and Well‐being There is no single indicator that measures emotional health and wellbeing for children and young people in Solihull, although the Health Related Behavioural Questionnaire (HRBQ) provides a useful proxy through a composite self esteem indicator. The self esteem composite covers questions of self image, self confidence and relationships with fellow pupils, teachers and parents. Results from the 32 ndicate that tthere is a correlation bettween low self esteem and fear of b ullying (altho
ough not HRBQ in
with thee experiencee of having b
been bullied – other corrrelations are satisfactionn with life, fe
eelings of safety and use of Class A drugs and volatilee substancess). Around 4
49% of respoondents to tthe 2010 bed as havin
ng high self eesteem, reprresenting an increase froom the 46% rrecorded HRBQ caan be describ
in 2007.. Those areas with fewer than 45% oof respondents meeting the high seelf esteem crriteria (in north So
olihull and Lyndon/Elmd
L
don in the uurban west)) have generally seen aa decline in the rate between
n 2007 and 2
2010. By contrast in soutth Solihull wh
here a majorrity of responndents have high self esteem the rate hass improved. It is worth noting, betw
ween the 20
007 and 20110 respective
e HRBQs, ho have beenn bullied at or near scho
ool in the 122 months prior to the that thee proportion of those wh
survey in
hull decrease
ed from 17.11% to 16.1%
% yet increase
ed from 19.88% to 22.2% in North n South Solih
Solihull. As the m
maps below sshow only a third of puppils in the mo
ore deprived areas have high self‐estteem (far more crritical for yeear 8 than year y
10 puppils) and the
e Fordbridge
e area (alongg with neighbouring postcodes in Chelmsley Wood) is also loweest in the Bo
orough for satisfaction w
with life. Pup
pils from Fordbrid
dge also worrry more abo
out crime thaan any otherr areas in the
e Borough, w
while just ove
er 60% of respond
dents said theey felt safe d
during the daay (and far fe
ewer after da
ark). Disorderrs of mentaal health, be
ehavioural pproblems an
nd poor emotional welllbeing are relatively r
common
n in children and young p
people. Locaal informatio
on about the mental and emotional w
wellbeing of childrren is limited
d; however e
estimates cann be derived from nation
nal data. It iss estimated tthat as at 2009 arround 3,800 children agged 5 to 16 years in So
olihull sufferr from somee form of diagnosed 33 mental disorder (1,785 conduct disorders, 1,139 emotional disorders including depression and anxiety, 462 hyperkinetic disorders and 400 less common disorders including autism, tics, eating disorders and selective mutism). Children with a mental disorder are more likely to be boys, living in a lower income household, in social housing and with a lone parent. Frequency increases by lone parenthood, reconstituted families, parents with no educational qualifications, and neither parent working. As such it can be estimated that the prevalence of these disorders will be higher among children living in areas of Solihull with higher levels of deprivation such as the north Solihull regeneration wards. Studies have also consistently shown that looked after children have poorer mental health than the rest of the population with the health of those in mental health worse than those in foster care. The following table provides an estimate of the number of children and young people aged 17 as at 2009 and under who may experience mental health problems appropriate to a response from CAMHS at Tiers 1 (Mental Health Promotion and Early Intervention), 2 (Service provided by specialist individual professionals relating to staff who work directly with children), 3 (Specialised multi‐
disciplinary service for more severe, complex or persistent disorders) and 4 (Highly Specialised Services such as day units, highly specialised out‐patient teams and in‐patient units ): Tier 1 (15%) Tier 2 (7.0%) Tier 3 (1.85%) Tier 4 (0.075%) 6,777
3,163
836
34
The children in need domain score of the 2009 Child Well‐being Index places Solihull in the top quartile (14th percentile) which is favourable when compared with the overall index (47th percentile). Other national comparisons that place Solihull in the top quartile include; hospital admission rate due to drug misuse (2005‐10, aged 15‐24), first time entrants to the Youth Justice System (2008‐09). Child Protection Comparison for children who are the subject of a child protection plan (CPP) across all local authorities reveals some key differences when comparing Solihull with England: Either as at 31st March 2011 of During the Year to: Child Protection Plans per 10,000 children (as at) Last category of Emotional Abuse % (as at) Under 1 % (during year) Solihull 43.0 44.1 3.0 England 38.7
28.2
14.9
Emotional abuse is defined as children who are witnesses to and/or are living with domestic abuse. The category of abuse for child protection is made by the chair of the conference that is deemed to be most reflective of the issue of concern and so is a perceived primary factor rather than being through proscriptive instruction. The second largest factor for Solihull is neglect with 32.2%, followed by sexual abuse (5.0%) and physical abuse (4.5%) – note that the remaining 14.4% present with multiple needs which are deemed to be relevant for the latest plan. Although small numbers need to be taken into context, children of Mixed origin are over three times more likely to be the subject of a CPP than might be expected by their population. There were 28 34 cases as at 31st March 2011 for this group compared with under three who were Asian – this latter group are over 1.5 times more populous than Mixed. Looked After Children Comparing Solihull with other local authorities is complicated by the relatively large Unaccompanied Asylum Seeking Children (UASC) population – a Local Authority responsibility due mainly to the UK Border Agency being based within the borough (this also applies significantly to Croydon and Hillingdon). In terms of Looked After Children (CLA) Solihull had 402 as at the 31st March 2011 with 278 (69%) being local citizens and 124 (31%) UASC. It should be noted that UASC are a specific cohort with health and well‐being needs that can relate to their circumstances, which can involve severe trauma resulting from both previous and current experiences, although their emotional health SDQ score (7.8) is actually more favourable than the local citizens (13.0) ‐ 47% of new starter UASC for the reporting years 2009‐10 and 2010‐11 were aged 16 or over and 57% have Afghan nationality. It is worth noting that only 64% of UASC aged 16 or over had a health or dental check up in the reporting year compared with 72% for the local citizen equivalent. The outcomes for the Solihull CLA population as at 31st March 2011 are broadly in line with peers, although note that this is now only possible through a regional benchmarking club (for the composite indicator below; Warwickshire 81.3%, Worcestershire 79.9%, Birmingham 72.4%). Immunisations Dental Health Health/Dental Composite Number with checks up to date 206
240
214
227
Number of CLA for a full year 284
284
284
284
Outturn 72.5% 84.5% 75.4% 79.9% CLA are likely to have additional needs compared to their peers, for instance there is a clear association between mental health and looked after status with 5‐10 year‐old looked after children being about five times more likely to have a mental disorder than children living in private households. As part of our OFSTED and CQC inspection action plan, Health and SMBC are working on the following: 


All CLA to have a health assessment, develop pathways to support take up especially for CLA out of the borough, and clarify the responsibilities of health commissioners and designated doctor; Also, develop, agree and commission care pathways for CAMHS service with a focus on UASC and out of borough CLA. Access and quality will be monitored including waiting times; Health and SMBC are also committed to improving access to health advice by offering young people placed within borough who refuse a health review, a designated nurse and will be offered a health dialogue with a relevant health professional/designated nurse. SMBC children’s placement strategy will embed health expectations on providers of supported accommodation to help improve children’s health. Analysis of the CLA population who had a placement at some stage during the 2010‐11 reporting year reveals that 61.3% of activity was in the three North Solihull Regeneration wards, only 35 accounting for 22.4% of the population aged under 20. This is a rate of 20.6 per 1,000 population aged under 20 compared with 3.8 for the rest of the borough (7.5 for Solihull overall). Smith’s Wood has by far the highest rate (27.2 per 1,000) with Knowle lowest (1.4) ‐ this suggests a strong association with deprivation. It should also be noted that children of Mixed origin are again over three times more likely to be looked after than their population might suggest. The Asian and Other ethnicities are again considerably less likely to be looked after. For the three year period up to 2010, Solihull reported on average 2% of CLA with missing from care incidents. This is 75th nationally (national average is 1%), although a large number of authorities submit incomplete or nil returns so its hard to draw conclusions. During 2010/11, there were 8 children reported as missing from care for more than 24 hours. The following table reveals the proportion and rates of Children In Need (CiN), CLA and children subject to a Child Protection Plan (CPP) by ward as at January 2012: Ward Bickenhill Blythe Castle Bromwich Chelmsley Wood Dorridge and Hockley Heath Elmdon Kingshurst and Fordbridge Knowle Lyndon Meriden Olton Shirley East Shirley South Shirley West Silhill Smith's Wood St Alphege Total Rate per 1,000 <20 CiN CPP CLA 28.5 3.6
5.9
6.3 0.0
2.2
10.7 2.1
1.2
Ward Proportion of Total CiN CPP CLA 7.2
6.3 7.3
1.7
0.0 2.8
2.1
2.9 1.2
66.5 12.3
9.0
19.6
25.3 13.0
5.1 0.0
1.7
1.2
0.0 2.0
18.2 47.9 2.9
7.9
2.2
13.2
4.1
15.6
4.6 17.8 2.4
21.1
5.5 22.0 6.5 10.7 17.4 10.3 22.3 11.1 70.1 7.3 24.0 1.4
2.4
0.4
3.3
2.7
0.8
2.4
0.8
9.3
0.0
3.5
1.8
2.8
2.2
3.3
3.1
3.6
2.4
2.8
15.9
1.0
4.9
1.0
5.9
1.5
2.4
4.2
2.1
5.3
2.3
21.9
1.8
100.0
1.7 4.6 0.6 5.2 4.6 1.1 4.0 1.1 20.1 0.0 100.0 1.6
3.7
2.4
3.7
3.7
3.7
2.8
2.8
24.4
1.2
100.0
Care Leavers The proportion of Care Leavers who are in education, employment or training on their 19th birthday from the 2010‐11 returns is very similar for local citizens (78.3%) and UASC (80.0%) – 79.5% overall. This compares favourably with the West Midlands 54% and England 61%. However, there is a gap for the proportion of Care Leavers again on their 19th birthday in suitable accommodation with 95.7% for local citizens (note only 23 were included in the sample) and 88.0% for UASC (90.4% 36 t
UASC outturn is inn line with the West Midlands M
levvel of 88% which is overall),, although the marginaally lower thaan the Englan
nd level of 900% and so doesn’t sugge
est any causee for concern
n. Wider Determin
nants of C
Children’s Well‐bein
ng The follo
owing modeel developed by Warwickkshire Obserrvatory generates a correelation coeffficient of 0.83. In other word
ds, there is a a statisticallyy significantt relationship
p between tthe two varriables of n entering caare and the
e unemploym
ment rate for the preceding year. Using the R‐square children
coefficieent, 68% of tthe variation in one is expplained by variation in th
he other. Agaain, it is important to emphasise that corrrelation does not prove causation; there t
may be b other variiables that can c more t relationsship betweeen demand for f care and
d unemploym
ment. Howe
ever, it is accurateely explain the suggesteed that changes in une
employmentt can act ass a useful in
ndicator of tthe likely ch
hange in demand
d for care in the following year. Thee economic ccircumstance
es of Solihulll are detailed
d later in this asseessment but it should be
e noted that the purpose
es of the Warwickshire m
model are for general observation and dem
monstration of the widerr determinan
nts for well‐b
being in geneeral. Safegu
uarding in
n Families Safeguarding is reco
ognised to be
e linked to inncreased stre
ess and presssures on fin ancial incom
me where children
n in families are at grea
ater risk of becoming a a child in need or subssequently ne
eeding a protection plan or being placed in Local Authhority care.
Other asspects of safeguarding for f children are evident from the lin
nk between domestic ab
buse and deprivattion appeariing to be sttronger amoong youngerr victims; for instance aa significantlly higher proportiion of youngg victims (age
ed 18 to 24) are from No
orth Solihull ((56% comparred with aro
ound 25% of the p
population), whereas older victims (aged 35+) are more likely to be ffrom the resst of the Borough
h (68% although around 8
80% of the ppopulation).
37 ncidents is the whole poopulation of children An addittional sourcee of evidencce for dome stic abuse in
subject tto triage from a domestiic abuse inci dent where the children
n live that haas been recorded and come to
o the attenttion of the police. In thhe 12 month
hs to March
h 2011 theree were 713 children recorded
d in this cateegory. It sho
ould be noteed that the d
data is record
ded by indivvidual childre
en rather than ho
ouseholds, so
o many of the incidentss may have involved sib
bling groups.. Given the different nature o
of the incidents and the reporting prrocedures it is recommended that thhis analysis is viewed separateely from anyy analysis of rreported pollice incidentss. 54% of the
e children reeceiving a tria
age were from No
orth Solihull. At a ward le
evel the patteern suggestss a clear asso
ociation with deprivation. Child SSexual Exp
ploitation Sexual eexploitation is a horrific form of sexxual abuse th
hat affects thousands off children an
nd young people eevery year in
n the UK. It can happenn to any young person frrom any bacckground and affects boys and young meen as well ass girls and yooung women
n. Many vicctims of childd sexual exp
ploitation have beeen groomed
d by an abusing adult, w
who will beffriend them and make tthem feel sp
pecial by buying ggifts or givingg them lots o
of attention. Victims are targeted botth in person and online. Some yo
oung peoplee – in particular those hhaving difficu
ulties at hom
me, those trruanting or excluded from sch
hool, those who regularrly go missinng from hom
me or care, or o those in ccare – may be more vulnerab
ble to exploitation. Child
dren and yo ung people who are victtims of this fform of sexu
ual abuse often do
o not recoggnise they are being ex ploited. How
wever, there
e a number r of signs th
hat could indicate a child is being b
groom
med for sexuual exploitatiion and, as a parent orr carer, you have an em and prot ecting childrren. important role in reccognising the
38 These signs include: 








going missing for periods of time or regularly returning home late regularly missing school or not taking part in education appearing with unexplained gifts or new possessions associating with other young people involved in exploitation having older boyfriends being preoccupied with their mobile phone, which could indicate the child is being controlled suffering from sexually transmitted infections mood swings or changes in emotional wellbeing drug and alcohol misuse 
displaying inappropriate sexualised behaviour The issue of child sexual exploitation has a significant profile at a national level including a Barnardo’s campaign to end child sexual exploitation (Cut Them Free campaign) along with a report called “Puppet on a String” which highlights the vulnerabilities of young people to grooming, the dynamics and impact of child sexual exploitation upon young people and finally gaps in agency responses. Solihull MBC has signed up to the Cut Them Free campaign. Post a high profile case (Operation Retriever: Derby) which saw multiple perpetrators convicted for the organised abuse (including internal trafficking) of many young people, the government commissioned Child Exploitation and Online Protection (CEOP) to produce a report on localised grooming. This report (“Out of Mind, Out of Sight”) made a series of recommendations to enhance the understanding of, and responses to, the problem including apprehension of offenders. A number of activities will be addressed at a sub regional level including links with guns/gangs strategy, review of complex case procedures, standard license conditions for under 18’s events, as well as a review of Crown Prosecution Service response to cases of child sexual exploitation. The issue of child sexual exploitation also needs to be addressed in the commissioning of the West Midland Sexual Assault and Referral Centre (SARC). Work is needed to engage local businesses e.g. hotels and venues which will attract young people unsupervised by their parents/carers such as ice‐
rinks, fast‐food outlets, shopping malls and cinemas. This is to support them to contribute to the Partnership work to prevent child sexual exploitation by sharing intelligence with local police. Licensed premises that host the under 18 events are also likely to be targeted by perpetrators and the LSCB, as a Responsible Authority under Licensing Act 2003, has the powers to impose conditions to promote the safety of children and young people. It is understood however that no such events are held in Solihull however a regional response to this creative approach to prevention is endorsed by Solihull LSCB. Hospital Admissions Injuries are a leading cause of mortality and morbidity in children and young people. They are also an important cause of inequality with higher rates in children from more deprived socioeconomic backgrounds. Effective interventions are available to prevent many injuries. The crude rate of hospital admission following all injury per 100,000 population, persons aged <18 years for 2010‐11 reveals Solihull at 1,185.4 is found to be significantly better than England (1,466.0) and West 39 ds (1,504.4). When analysed by Miiddle Layer Super S
Outpu
ut Area (MSO
OA) over the period Midland
from 20006‐11 there is found to be a clear li nk with dep
privation, as five of the w
worst six MSOAs (out 29) are iin the Regen
neration ward
ds (Hospital Episode Stattistics). Howeveer, the inpatient admission rate per 100,000 po
opulation age
ed 0‐17 yea rs for mental health disorderrs at 122.5 iss worse (tho
ough not signnificantly) th
han both Eng
gland (109.4)) and West M
Midlands (104.4) –– although this only acco
ounts for 55 episodes. TThis is imporrtant becausee one in ten children aged 5‐116 years hass a clinicallyy diagnosablee mental he
ealth problem
m and, of addults with lo
ong‐term mental h
health probllems, half will have expeerienced the
eir first symp
ptoms beforee the age of 14. Self‐
harmingg and substance abuse a
are known too be much m
more commo
on in childreen and young people with meental health disorders – with ten peer cent of 15
5‐16 year old
ds having sellf‐harmed. FFailure to treat meental health disorders in
n children ca n have a devastating impact on theiir future, ressulting in reduced
d job and life expectation
ns. Mental h ealth linked alcohol adm
missions repreesent the ma
ajority of alcohol aadmissions ffor those und
der the age oof 16. Hospitall admissionss for self‐ha
arm in childdren (expre
essed here as a crude rate of em
mergency admissio
ons for self‐‐harm (0‐17 years) per 1100,000 pop
pulation aged 0‐17 yearrs) have incrreased in recent yyears, with admissions for young ffemales bein
ng much hig
gher than addmissions fo
or young males. W
With links to other menta
al health connditions such
h as depressiion, the emootional cause
es of self‐
harm may require p
psychological assessmentt and treatm
ment. Solihulll with 70 eppisodes has a
a rate for w
is in lin
ne with Eng land (158.8)) and margin
nally better than West Midlands M
2010‐111 of 156.0 which (169.3). 40 Reach of Children’s Centres There are 13 children’s centre areas within Solihull and 12 main sites, although it should be noted that there are further satellite sites and that some sites serve more than one area. The following table provide disaggregated information, as some of the later phase areas are geographically quite large: Children's Centre Area (CCA) 0‐4 Year Old Population (Estimated 2010) Within Lone Parents BAME in CCA Solihull (%) in CCA (%) (%) 8.6 30.8
12.2
6.5 29.6
15.8
3.8 28.3
16.2
4.7 29.7
14.4
3.7 17.1
18.8
6.7 10.9
32.4
6.4 13.5
22.5
6.7 13.7
20.6
6.3 13.9
23.4
8.4 11.9
26.3
4.2 15.8
11.9
5.1 10.3
39.4
6.8 7.4
13.6
7.3 10.1
24.3
3.9 7.4
7.4
5.8 6.9
12.5
5.0 7.9
23.4
* EYFS Score, 2010 (%) 60.9 47.0 53.8 61.9 72.4 72.8 63.2 75.0 64.4 78.8 61.3 70.7 71.0 79.4 85.7 84.2 65.4 Children in Poverty, 2008 (%) 52.1 50.6 46.5 45.1 19.7 15.4 14.7 12.9 10.9 10.3 10.2 8.4 6.3 4.1 3.3 3.0 0.9 Chelmsley Wood Smith's Wood Fordbridge Kingshurst/Yorkswood Marston Green Langley Lyndon Mill Lodge Elmdon Shirley Heath Castle Bromwich Silhill Rural (East) Monkspath (Blythe) Keystone (Knowle) Keystone(D&HH) Monkspath (St Alphege) *Proportion of children achieving 78+ points in Early Years Foundation Stage (EYFS) with 6+ points in each of the Personal Social and Emotional Development (PSED) and Communication, Language and Literacy (CLL) scales 41 Prioritties for Co
ommission
ning •
Improve thee quality of m
maternity serrvices with a focus on sup
pporting fam
milies, stopping smoking and
d supporting breast feed ing; •
Maintain tarrgeted investtment in earrly years development; •
Prioritise evidence‐based parenting support proggrammes, ch
hildren’s cen tres; •
Provision of good qualityy early yearss education aand childcare
e. 42 EnableAllChildren,YoungPeopleand
AdultstoMaximiseTheirCapabilities
andHaveControlOverTheirLives
Key Findings Older People •
The elderly population is projected to increase significantly over the next 10 years; (14% increase in the over 65’s; 44% increase in the over 85’s); •
There are large numbers of people suffering from long term conditions, depression, dementia, mobility problems; they are expected to increase considerably over the next 10 – 20 years; •
The need for health and social care will increase considerably; the impact has been quantified using existing planning models; •
Modeling shows that the demand for institutional care will increase dramatically over this time period; •
An estimated 21,000 carers provide invaluable support to the care of people; 40% of carers are >65 years and will themselves require support; •
The profile of social care clients is similar to the national (e.g. with regard to social needs, levels of satisfaction and quality of life); •
Solihull clients report comparatively lower levels of contact with other people and less control over their lives; •
Access to social care is lower than national averages, with the exception of learning disabilities; •
Social care performance has improved but provision of intermediate care/rehabilitation, and residential care for people with learning disabilities compares poorly; •
There are comparatively high levels of spend in learning disability services and day/domiciliary care. Education and Skills •
Educational outcomes have improved over the last 5 years: from 50% to 61% (5 A*‐C GCSEs) and is higher than England average (58%); •
Educational outcomes vary across Solihull: by area, by school and by specific groups e.g. SEN, LAC; 43 •
Adults of working age ‐ comparatively good levels of skills and qualifications; varies across Solihull. Introduction In order for people to maximise their capabilities and have control over their lives they must have the tools with which to make informed choices about their own health and care needs and have access to services that are tailored to fit their needs. In terms of providing people with the tools to make informed choices providing children and young people with the best start in life and education are critical. Tailoring services to allow people to have control over their own lives is central to Solihull’s transformation of Adult Social Care, one of the Council’s top five priorities under the banner of Putting Solihull People First. Transforming Adult Social Care The Putting Solihull People First transformation programme builds on the new national policy framework outlined by the Government in A Vision for Adult Social Care (Department of Health, 2010) and Think Local, Act Personal (DH, 2011), which place user choice and prevention at the heart of its vision. It is also taking place in a challenging financial climate, with central Government funding to Local Authorities being cut. In responding to the Government’s agenda for Adult Social Care, the financial climate and the increasing pressures on care services (arising out of demographic change) Solihull Council has adopted the following priorities to ensure that we make significant progress:








Focus on prevention: focus on re‐ablement services which help service users regain and maintain independence; reduce, delay or avoid the take up of more intensive forms of care and support; and adopt early intervention as a key component of prevention to avoid crisis. Promote health and wellbeing: support people and communities to take greater responsibility for their own health and wellbeing. Modernisation: develop a strategic approach to universal services (services that anyone can access and are available to all); increase access to direct payments and personal budgets; provide improved access to services. Increase choice and control: provide services that are fair, accessible and responsive to individual needs. Safeguarding: provide protection from abuse, harassment, neglect and self‐harm but support services in being innovative or radical where necessary. Efficient use of resources: develop shared services; a co‐ordinated approach across the Council and with partners; and secure value for money. Social Capital: increase user participation, volunteering and community cohesion. Workforce development: develop an integrated approach to increasing service capacity, productivity, competence and standards. 44 Demographics and Need Significant developments in public health and awareness, overall national and personal prosperity and access to ever more sophisticated healthcare means that people are now living more than 20 years longer than at the end of the 1930s. Those aged 85 and over represent the fastest growing section of society, doubling between 1984 and 2009 and projected to increase by a further 2.5 times by 2034, accounting for 5 per cent of the total population. For many, extended retirement years offer new opportunities in terms of increased financial and social freedom, but an ageing population also creates additional pressures on health and care services. For instance, the number of older people in the UK in need of care and support is expected to soar by 1.7 million over the next 20 years and the number with dementia could double in 30 years. In 2001 there were 33,700 people aged 65 and over living in Solihull, representing 17% of the population. Of these 3,600 (10.7% of the 65+ group and 1.8% of the total) were aged 85 and over, the group most in need of social care services and most likely to display multiple or complex care needs. By 2010 the 65+ population in the borough had increased by 14.2% to 38,500 and the 85+ population by 44% to 5,2001. The key point is that not only has the 65+ population increased by more than the rest of the population (working age population has increased by around 3%), but that proportionately more people of retirement age and by extension the whole population are in the most vulnerable 85+ group, which now represents 14% of the 65+ population and 2.5% of the total population. ONS population projections2 show that this pattern is set to continue. By 2015 it is estimated that the 65+ population will total 43,100 (an increase of nearly 12% on 2010 as the “Baby Boom” generation reach retirement age) and the 85+ population 6,400 (nearly 15% of 65+ population and 3% of total). The comparable figures at five year intervals are provided in the table below, up to 2030 when it is projected that the 65+ population will have grown to 53,500 and the 85+ population to 10,500 (20% of 65+ population and 4.6% of total population). It is, however, worth speculating that the age at which older people most commonly require the support of social services will increase over this timeframe and that for instance the 90+ age group will become more critical in terms of service provision. Once again this age group is projected to see rapid increases over time and is likely to represent a growing proportion of the total population (from 1,600 persons in 2010 or 4.2% of the 65+ age group to 4,500 or 8.4% by 2030). Population Change Among Older People in Solihull 65+ Total 85+ Total 65+ 5 year 85+ 5 year 85+ prop of 85+ prop of (000s) (000s) Increase Increase total pop 65+ pop 2001 33.7 3.6 1.8% 10.7% 2005 35.0 3.9 1.9% 11.1% 2010 38.5 5.2 10% 33% 2.5% 13.5% 2015 43.1 6.4 12% 23% 3.0% 14.8% 2020 45.5 7.3 6% 14% 3.4% 16.0% 2025 48.8 8.7 7% 19% 3.9% 17.8% 2030 53.5 10.5 10% 21% 4.6% 19.6% Source: Census, ONS mid‐year population estimates, ONS sub‐national population projections 1
2
ONS mid‐year population estimate 2010 ONS sub‐national population projections, 2008 45 The chart below shows the population projections for older people in Solihull by five year age bands from 65+. This shows that there are two factors influencing the ageing population. Firstly, a ripple effect caused by increasing birth rate during the “Baby Boom” generation, which is evident in those aged 65‐69 (peaking 2014), in those aged 70‐74 (peaking 2019) and those aged 75‐79 (peaking 2024). Secondly there is the effect of medical advances, including improved treatment and prevention, which is driving the fact that people are living longer. This is most evident from the fact that the number of people aged 85‐89 and 90+ are projected to increase throughout the next 20 years, irrespective of any “Baby Boom” effect. The general ageing of the population will result in a fall in the support ratio (the number of people of working age), although changes to the retirement age and people working beyond retirement age will, to an extent, offset this. In 2010 there were 3.5 persons of working age (16‐64 years) in Solihull for every person aged 65 and over. This ratio is projected to fall to 3 by 2020 and to 2.7 by 2030. In Solihull projections from the Institute of Social Care3 highlights some of the challenges arising from a rapidly increasing population of older people. Over the next 20 years it is estimated that the number of people in the borough aged 65 and over with dementia will rise by nearly 75%, with similarly large increases in those suffering mobility problems, depression and limiting long‐term illness. With an increasing population of older people living alone and more older people acting as carers the pressures on social care services will continue to rise. Care services will need to respond to the fact that the number of people with a limiting long‐term illness aged 65 and over is projected to increase by 44% between 2010 and 2030 (from 17,197 to 24,735), with the numbers aged 85+ more than doubling. 3
POPPI 46 Limiting Long Term Illness % Increase 2010 2015 2020 2025 2030 2010‐2030 Aged 65‐74 7,118 8,124 8,017 7,801 8,843 24% Aged 75‐84 6,982 7,293 8,223 9,516 9,516 36% Aged 85+ 3,097 3,886 4,433 5,283 6,376 106% Total aged 17,197 19,303 20,673 22,600 24,735 44% 65+ Source: POPPI Unsurprisingly this increase in the number of older people with a limiting long‐term illness is expected to be accompanied by a rise in the number of individuals unable to manage at least one domestic task or self‐care activity. Domestic Tasks and Self Care % Increase 2010 2015 2020 2025 2030 2010‐2030 Unable to Manage at 15,833 17,914 19,420 21,458 23,750 50% Least One Domestic Task Aged 65+ Unable to Manage at Least One Self 12,974 14,682 15,864 17,535 19,462 50% Care Activity Aged 65+ Source: POPPI As well as resulting in an increase in the absolute number of older people with care needs the ageing population will also mean that more older people will be carers. It is estimated that between 2010 and 2030 the number of people aged 65 and over caring for a partner, family member or other person will increase by 32% (from 4,500 to nearly 6,000), with proportionally larger increases among older people in this group. Providing unpaid care to a partner, family member or other person % Increase 2010 2015 2020 2025 2030 2010‐2030 Aged 65‐74 2,883 3,290 3,247 3,159 3,581 24% Aged 75‐84 1,394 1,456 1,642 1,900 1,900 36% Aged 85+ 245 307 350 417 503 105% Total aged 65+ 4,522 5,054 5,239 5,477 5,985 32% Source: POPPI Similarly, the POPPI projections show that more older people will be living alone or living, with again the increase greatest among the oldest. 47 Living Alone % Increase 2010 2015 2020 2025 2030 2010‐2030 Aged 65‐74 4,980 5,750
5,630
5,490
6,230 25%
Aged 75+ 9,314 10,237
11,472
13,426
14,308 54%
Source: POPPI Alongside the overall ageing of the population other demographic factors are projected to increase the pressure on care services. In particular, individuals with complex needs and adults with learning difficulties are living longer. Some of these key client groups are considered below. Key Client Groups Learning Disability (LD) is relatively common affecting 2% of the national population which would equate to approximately 4,100 people in Solihull, while severe learning disabilities are less common affecting around 0.4% of the population (approximately 800 people in Solihull). Condition1 National Prevalence Mild Intellectual Impairment Mild Learning Disabilities (Mild Intellectual Impairment with Additional Problems) Severe Learning Disabilities 2.3% 1‐2% 300‐400 per 100,000 population Estimated Numbers in Solihull 4,740 2,060 – 4,120 620 – 825 The prevalence of Severe Learning Disability is increasing at a national level by just under 1% per year; Severe or Moderate LD is forecast to increase in Solihull by 11% from 2011 (775 aged over 18) to 2030 (858) in Solihull2. This increase is as a result of people living longer, increased survival of children and young people with life threatening conditions, and increased life expectancy of people who have a learning disability. As the general population becomes proportionately older the age profile of people with learning disabilities is also changing. Early onset dementia in people with LD is also potentially becoming more common, although this is likely to have a far smaller impact. Evidence4 suggests that adult social services will need to meet growing demand for care services from adults with learning difficulties with the numbers of adults with learning difficulties in England rising due to three main factors:  Decreasing mortality among people with learning disabilities, especially in older age ranges and among children with severe and complex needs;
 The impact of changes in fertility over the past two decades in the general population;
 The ageing of the ‘baby boomers’, among whom there appears to be an increased incidence of learning disabilities.
It is predicted that these demographic changes will result in a significant increase in the numbers of older people with learning disabilities and young people with complex needs and learning disabilities Estimating Future Need for Adult Social Care Services for People with Learning Disabilities in England, E. Emerson & C. Hatton, Centre for Disability Research (2008) 4
48 requiring support. These increases are likely to be associated with even greater changes in demand for support due to a range of factors that will act to reduce the capacity of informal support networks to provide care, networks that have primarily relied on the unpaid labour of women. These include:  Increases in lone parent families;
 Increasing rates of maternal employment;
 Increases in the percentage of older people with learning disabilities (whose parents are likely to have died or be very frail);
 Changing expectations among families regarding the person’s right to an independent life.
However, the factors that are leading to increased need and demand are operating at a time of decreasing birth rates in the general population. For example, the number of children in England aged below one dropped by 15% from 660,000 in 1991 to 558,000 in 2001. Since 2001 birth rates have begun to increase, with the number of children in England aged below one rising to 620,000 in 2006. While the impact of changes in birth rates will, to an extent, be modified by reductions in child mortality, the number of children currently reaching adulthood is expected to decrease from 2008 to 2018, after which it will begin to rise. Future demand for services among the adult population with Learning Difficulties will also depend on policy decisions around eligibility for services (the extent to which services will be provided to all new entrants with critical, substantial or moderate needs). Emerson and Hatton note that rationing access to social care to those with just critical or substantial needs is incompatible with current policy objectives for adult social care services. On this basis their projections of need vary from an increase of 3.20% (lower estimate, services provided to 50% of new entrants with moderate needs) to 7.94% in the number of adults with learning disabilities receiving services from adult social care between 2009 and 2026. High numbers of clients with learning disabilities in Solihull mean that there will be a high number of people with early onset dementia. It is essential that we ensure that there are services, support and information and advice on dementia which are accessible for people with a learning disability. This can be achieved through close working with the commissioner for learning disabilities and agreeing how best dementia and learning disability services can work together in meeting the needs of this population. About 20% of people with a Learning Disability have Downs Syndrome and people with this condition are at particular risk of developing Alzheimer dementia. It should be noted that an estimated 25–40% of people with learning disabilities have mental health problems. Mental illness is a common condition affecting one in six people at some point during their life. The most common mental health problems in Solihull are neurotic disorders and depression. Large numbers of people in Solihull, over 24,000 people, are estimated to be suffering from these conditions ‐ this represents 1 in 6 of the population aged 15‐74. These conditions are more common in women and affect all age groups (19.7% of women have a common mental disorder compared with 12.5% of men2). These conditions are almost three times more common in the wards in the North of Solihull, suggesting an association with deprivation. The following table shows prevalence rates and population estimates for adults aged 15‐74 with common mental health problems: 49 Condition3 Mixed anxiety and depressive disorder Generalised anxiety disorder Depressive episode All phobias Obsessive compulsive disorder Panic disorder Any neurotic disorder Prevalence Rate 8.8% 4.4% 2.6% 1.8% 1.1% 0.7% 16.4% Estimated Numbers in Solihull 13,250 6,630 3,920 2,710 1,660 1,050 24,700 Mental health and wellbeing are both areas that have been previously marginalised and neglected. This relates to the historical stigma and lack of understanding attached to mental illness. Mental health problems are more common than most people realise. At any one time, one in six people may be suffering from a mental health problem. Mental health, physical health and social well‐being are interlinked and cannot be considered in isolation. Whilst good mental health is a key factor in successful psychological and social functioning, poor mental health has been associated with poor socio‐economic status, poor educational outcomes, high crime levels, unemployment and poor quality of life. The South East has the highest rates of sickness absence in the country, of which mental illness and stress related illnesses are the largest factors. Solihull has relatively few mental health admissions per 1,000 population, with rates almost half the regional and national average. Solihull admission rates have fallen by almost 50% over the last five years (2005‐06 to 2009‐10). The population of Solihull also occupy far fewer overnight bed days per 1,000 population than the regional and national average, the rate has almost halved between 2005/06 and 2009/10. However, there has been an increase in new permanent older adult mental health placements from 48 in 2010‐11 to 67 in 2011‐12 Older people, potentially facing social isolation and other forms of ill health, a particularly at risk of depression. POPPI estimates suggest that the number of people aged 65 and over suffering from depression will increase by 39% between 2010 and 2030 (from 3,325 to 4,637) with proportionally larger increases among older age groups. Similarly, the prevalence of severe depression among the over 65s is projected to increase by 44% over this period (from 1,056 to 1,523). % Increase Prevalence of Depression and Severe Depression 2010 2015 2020 2025 2030 2010‐2030 Depression All 65+ 3,325 3,739 3,921 4,226 4,637 39% Depression 80+ 1,035 1,146 1,279 1,492 1,780 72% Severe Depression All 1,056 1,187 1,260 1,397 1,523 44% 65+ Severe 379 433 486 573 686 81% Depression 80+ Source: POPPI Research by the Alzheimer’s Research Trust 20105 suggests there are about 820,000 patients in the UK with dementia representing 1.3% of the UK population. Dementia is a term used to encompass a 5
Dementia 2010: The Economic Burden of Dementia and Associated Research Funding in the UK 50 group of illnesses that cause progressive damage to the brain resulting in its function being impaired (can lead to changes in behaviour and mood, and affect day to day activities like cooking, personal care and health management). It is estimated that some 15,000 people under the age of 65 have the condition, which would result in a dementia rate among the over 65s of 7.8%. The report also notes that there is a significant gap between the expected number of people with dementia and the number of diagnoses made in the UK: only 60 of the expected 122 people with dementia per 1,000 people over 80 years of age have been formally diagnosed. This is because of a range of barriers to diagnosis, including:  fear of the disease in the patient or family;  inability to separate dementia symptoms from normal ageing process;  GPs’ lack of training and confidence in diagnosing dementia;  unclear roles or inconsistent approaches of specialist services such as Memory Services;  variation and inconsistency in the available diagnostic tools. Given the association between dementia and an ageing population, the number of people living with dementia is projected to increase sharply between 2010 and 2030. There are an estimated 2,723 people over the age of 65 currently with dementia in Solihull (POPPI, 2010) with this number projected to increase by 70% to 4,638 by 2030. This increase is expected to be proportionally greater among older age groups as the older a person gets, the more likely they are to develop it (approximately 1 in 20 people aged over 65 years; 1 in 5 over 80 years; approaching almost 1 in 3 by age 90). According to the Mental Health Needs Assessment (Solihull Care Trust, 2011) Solihull at 8% is lowest in the West Midlands region for the percentage of people with dementia receiving community based services. Dementia % Increase 2010 2015 2020 2025 2030 2010‐2030 Aged 65‐69 135 156 131 145 167 24% Aged 70‐74 240 275 316 272 303 26% Aged 75‐79 436 470 534 628 541 24% Aged 80‐84 721 734 801 932 1,100 53% Aged 85‐89 711 822 883 1,017 1,195 68% Aged 90+ 480 687 862 1,041 1,334 178% All Aged 65+ 2,723 3,143 3,527 4,035 4,638 70% Source: POPPI Physical disability is relatively common; nationally one in ten people are classified as disabled under the Disability Discrimination Act (DDA disabled) while one in twenty of the population have a serious disability, which would equate to around 20,600 and 10,300 people respectively in Solihull. Disability most commonly results from conditions such as arthritis, sensory and hearing impairment; more severe forms of disability result from rarer conditions such as cerebral palsy, multiple sclerosis, Parkinson’s disease or motor neurone disease. Those conditions, and the associated disabilities, that are more prevalent in older people will increase in number as the population increases and ages. 51 Carers Census 2001 indicates that there were nearly 21,000 carers in Solihull equating to 10.5% of the total population, higher than the national average of 9.9%. Given that many people do not recognise themselves as carers (according to research by Carers UK nearly a third of carers do not recognise themselves as such for over 5 years) and that the number of carers is increasing across the country (research by Carers UK estimates a 60% increase in the number of carers by 2037) the actual number of carers in Solihull is almost certainly higher than Census figures suggest. The majority of carers both locally and nationally care for somebody for between 1 and 19 hours per week, although a significant number (5,800 people in Solihull) were committed to over 50 hours a week of care. Total Carers Provides 1 to 19 hours care a week Provides 20 to 49 hours care a week Provides 50 or more hours care a week Source: Census 2001 Solihull Number of % of Carers
Population
20,987 10.5% 15,095 7.6% 2,092 1.0% 3,800 1.9% England % of Population
9.9% 6.8% 1.1% 2.0% In terms of local distribution the proportion of people identifying themselves as cares in the 2001 Census were highest in the urban west and semi‐rural south and east of the borough (both 11% of the total population) and lower in the regeneration area (8.9%). However, the regeneration area has the highest proportion of people caring for 50 hours or more a week (2.7%). Carers as proportion of total population
6.8 - 8.5%
8.5 - 9.9%
9.9 - 11.3%
11.3 - 12.7%
12.7 - 14.9%
Source: Census 2001
The 2010 Carers User Experience Survey indicates that 31% of carers in Solihull spend 100 hours or week or more looking after or helping the person for whom they care, with 49% caring for 35 hours per week or more. The majority of carers from this survey reported that they were retired (58%), 52 with just 9% in full time employment (including self employed) and a further 13% in part time employment (including self employed). 12% of those surveyed reported that they were not in paid work. 40% of carers responding to the survey were aged 65 and over. Solihull Carers Survey 2010
Employment status
25
Number of hours of care
15
32
60
41
131
13
5
51
291
48
41
28
Retired
Employed p‐t
Self employed p‐t
Voluntary work
Employed f‐t
Self employed f‐t
Not in paid work
Other
47
0‐9 hours
10‐19 hours
20‐34 hours
35‐49 hours
50‐99 hours
100 hours+
Source: Solihull MBC
By 2037, it’s anticipated that the number of carers in the UK will increase to nine million6 (from six million in 2001). If this 50% increase were applied to Solihull there would be approximately 31,500 carers in the borough at that point. A figure which does not take into account other demographic changes such as the ageing population. The Council recognises the immense value provided by the borough’s carers and will look to support them in their role and ensure their own good health and well being. Following consultation with local carers and professionals from health, social care and the voluntary sector the Council has refreshed the Solihull Carers Strategy 2010 – 2015, and have identified the following priorities:  Enable Carers to be supported so that they can formally identify themselves as carers.  Improve the assessment process for carers by introducing a “one‐stop‐shop” (single point of contact) for carers’ services.  Ensure carers have access to the integrated and personalised services they need to support them in their caring role.  Ensure that carers have a life of their own alongside their caring and that they are not forced into financial hardship by their caring role.  Ensure that carers are supported to stay mentally and physically well and treated with dignity and respect. 6
Carers UK 53 The Council will continue to work in collaboration with partners to implement this Strategy and are able to report a number of recent successes:  Development and implementation of the Carer Aware e‐learning course which raises awareness of the caring role with professionals and the public. The course went live in July 2011 and feedback shows that 97% of people completing the course discovered new information.  The Solihull Carers’ Strategy Group continues to meet and contribute to the development and implementation of the Carers Strategy.  The implementation of the Stroke Support Group in partnership with health colleagues at Solihull Primary Care Trust and the Stroke Associations. Types of Clients The table and chart below show the distribution of adult social care clients by client type in Solihull in 2010/11. Physical disability accounts for around 68% of all clients (79% of those aged 65+ and 40% of 18‐64 year olds), mental health including dementia for 16% (12% 65+, 26% 18‐64) and learning disability 10% (1.4% 65+, 33% 18‐64). Physical Disability Total Social Care Clients In Solihull 2010/11 by Client Type Age 18 to 64 Age 65 and over Of Which: Physical disability, frailty and / or temporary illness Hearing impairment Visual impairment
Dual sensory loss Mental Health Total Of Which: Dementia Learning Disability Substance Misuse Other Vulnerable People All Service Users Source: NASCIS (RAP) Total 605 3,060 3,665 40 960 1000 0 20 20 30 0 180 25 210 25 390 470 855 10 290 300 490 55 545 5 5 10 15 305 320 1,505 3,890 5,395 54 Compared with England and the West Midlands Solihull has fewer Adult Social Care clients per head of population; for all aged 18 and over Solihull’s client rate is 3,345 per 100,000 population compared to the England rate of 3,820 and the West Midlands 3,775. In terms of 18‐64 year olds the overall rate in Solihull is 1,225 per 100,000 compared to 1,570 for England and 1,530 for the West Midlands. Solihull’s below England average rate is particularly notable in respect of mental health clients (‐41% below England) and physical disability clients (‐15%). Learning Difficulties is the only client type where the rate in Solihull is higher than the England average (400 per 100,000 compared to 395). 55 1
per 100,000 1
com
mpared to 12
2,340 for In termss of the 65++ age group the rate in Solihull is 10,065 England and 11,725 for England. Again, withh the exception of other vulnerable ppeople the in
ndividual client rates in Solihu
ull are significcantly below
w average. The table below sho
ows the tota
al and breakkdown of ne
ew clients in Solihull ass essed betwe
een April 11. The ‘clien
nts assessed ’ statistics acct as a signpost, identifyiing issues ne
eeding to 2010 and March 201
be addreessed by servvice providers. New Clientts Assessed in 2010/11 b
by Client Typpe Othher Phyysical Mental Learning Substance Vulneerable Health Disability
Misuse
Disaability e Peoople Total Age 18 tto 300 40
30 10 10 390
0 64 Age 65 aand 1620 100 0 0 45 1,76
65 over Total 1,920
0 140 30 10 50 2,15
50 Source: NASCIS Looking at 18‐64 yeear olds, 77% of new cclient assessments in So
olihull were physical disability, a substanttially higher proportion than either tthe England (45%) or West Midland s averages (44%). By contrastt, Solihull had proportion
nally far few
wer assessme
ents involving mental heealth clients over this period (10% comparred to 43% for England aand 42% for the West Midlands). It sshould be no
oted that h social care clients undeer the age off 65 will be a
assessed by the Birmingham and most Meental Health
Solihull Mental Health Trust. 56 Physical disability clients also accounted for by far the largest proportion of assessments for new clients among those aged 65+ (92%). Distribution of Social Care Clients in Solihull The following charts reveal that the demand for Adult Social Services increases with deprivation. This may be due to environmental factors regarding deprivation considered throughout this assessment for those under the age of 65. However, for older people the impact of deprivation is also linked with the ability to self fund as well. 57 Using actual client data from mid January 2012 for those aged between 18 and 64, Mental Health and Learning Disability are found to have stronger associations with deprivation than Physical Disability (PD), nevertheless, Kingshurst and Fordbridge has by far the highest rate for PD with 31 clients at a rate of 41.9 per 10,000 population aged 20‐64. Learning Disability is also significantly higher in Chelmsley Wood (65.0) and Bickenhill (60.8) than elsewhere (36.0). Finally, Mental Health shows the greatest concentration within the Regeneration wards overall with 37.1% of the clients compared with 18.5% of the borough population aged 20‐64. Adult Services Rate per 10'000 (20‐64)
140
120
100
Learning Disability
Mental Health
Physical Disability
80
60
40
20
0
The following chart highlights a modest association with deprivation but in terms of numbers this is less pronounced, as the Regeneration wards only account for 17.6% of clients aged 65 or above receiving services compared with 13.9% of the borough population. A further observation of note is the differential between males and females, with males (4.1% of males aged 65+) only having a rate of service take‐up about half that of females (7.8%). There is no discernible pattern across the borough but this gender gap should be explored further to determine whether there is any unmet need and if so, what impacts this might have on other service areas. 58 Older People Services (Proportion 65+)
14
All
Female
Male
12
10
8
6
4
2
0
Ward Bickenhill Blythe Castle Bromwich Chelmsley Wood Dorridge & Hockley Heath Elmdon Kingshurst & Fordbridge Knowle Lyndon Meriden Olton Shirley East Shirley South Shirley West Silhill Smith's Wood St Alphege Solihull 18‐64
Learning Mental Health
Disability % Rate % Rate
10.7 60.8 11.8 27.0
4.3 21.9 3.5 7.3
4.7 29.5 2.4 5.9
Physical Disability %
Rate
7.6
29.7
4.2
14.6
6.2
26.6
Older People Female %
8.1
2.8
5.6
Rate
9.2
3.9
5.8
10.9 65.0 12.4 29.7
6.2
25.4
6.3
4.7 33.3 2.9 8.3
3.8
18.3
5.7 9.5 35.4 54.1 3.5 11.2 8.8
25.7
5.5 4.5 1.9 6.6 7.6 3.3 5.9 6.4 5.9 1.9 100 40.3 25.2 12.1 42.1 50.7 20.6 35.5 42.4 35.1 11.0 36.0 8.2 4.1 1.8 8.2 1.8 4.7 4.1 3.5 13.5 2.4 100 24.5
9.3
4.5
21.0
4.7
11.7
9.9
9.4
32.3
5.5
14.5
4.5
10.
7 3.1
6.9
5.5
6.6
5.5
8.0
7.6
3.5
7.3
2.8
100
All
Male
% Rate 8.0 11.9 2.7 5.1 5.2 6.7 % 8.2
3.0
6.4
Rate
5.9
2.6
4.4
8.2
6.0 10.2 6.9
5.7
4.3
4.7
4.5 6.4 3.6
2.6
19.2
41.9
5.6
5.4
5.6
6.7
4.7 5.4 6.0 8.1 7.8
5.4
5.1
4.7
15.8
26.6
24.2
28.6
25.3
33.8
31.3
15.7
29.5
11.0
24.7
4.2
8.3
6.7
8.1
6.3
6.9
6.2
6.4
5.9
2.9
100
4.2
7.9
6.5
7.1
6.3
5.9
6.4
5.5
8.7
2.9
6.2
4.4 8.6 6.7 8.1 6.8 6.7 6.7 6.6 5.9 3.2 100 5.6 10.0 8.5 8.7 8.5 6.8 8.5 6.8 11.3 4.2 7.8 3.7
7.6
6.6
8.1
5.2
7.6
5.2
6.0
6.1
2.2
100
2.5
5.0
4.0
4.8
3.5
4.6
3.6
3.6
5.6
1.4
4.1
59 User Perceptions of Adult Social Care Services in Solihull The User Experience Survey Programme operates on an annual basis and is used to target areas of particular interest within Adult Social Services. Opinions are sought over a range of service areas to gain an understanding of service users' views rather than measuring quantities of care delivered. This survey is the first of its kind to cover all service users aged 18 and over receiving services funded wholly or in part by Social Services, and aims to learn more about whether or not the services are helping them to live safely and independently in their own home and the impact on their quality of life. 91.4% of all respondents in Solihull indicated that they are satisfied with the care and support services they receive, compared to 89.9% across England as a whole. With 2.7% indicating that they are dissatisfied, Solihull’s positive balance of 89% ranks the borough 49th out of 145 Local Authorities in England (67th percentile, 2nd quartile). However, the proportion of Solihull respondents providing the most positive response is relatively lower. Based on respondents who completed the standard survey7, 21% indicated that they are extremely satisfied with the care and support they receive compared to the England average of 26%, placing the borough on the 18th percentile (bottom quartile). With regards to specific aspects of lifestyle and circumstance, in common with respondents across England as a whole, Solihull respondents have a more positive experience in relation to practicalities than they do with regards to wider lifestyle issues. Across all aspects the balance in Solihull is less positive than the England average. Solihull had a positive balance (good or adequate, against inadequate or bad) of at least 84% for each of comfort of home, provision of food & drink, personal 7
Excludes respondents of the easy read version, which has fewer response options (ie no LD clients) 60 safety and personal care (clean and presentable). By contrast, contact with people, control over daily life and the ability to do valued and enjoyable things all had balances below 50%. 53% of Solihull respondents indicate that their house meets their needs very well with a further 33% saying that it needs most of their needs (which are in‐line with the England response rates of 52% and 34%). At the other end of the spectrum just 2% of respondents think that their home is totally inappropriate for their needs. In terms of information provision the Solihull response is slightly less favourable than the England average. However, 51% of respondents in Solihull indicated that in the last year they found it either fairly easy or very easy to find information about support, services or benefits (compared to the England average of 55%). 21% of Solihull respondents say that finding information was either fairly or very difficult. 61 The survey provides some insight into the needs and requirements of respondents and the services they currently receive. In terms of the care and support that respondents receive the Solihull profile is broadly in‐line with the England average, albeit with a notably higher proportion receiving help with personal care (71% compared to 66% nationally) and more receiving support in terms of social contact (49% compared to 46%).
62 In terms of regular daily tasks dealing with finances and paperwork causes respondents most difficulty, with 84% of Solihull respondents indicating that they either have difficulty or can’t do it, substantially above the England average of 72%. Taking a bath or shower (70%) and getting dressed or undressed (58%) are the other daily tasks that more than half of Solihull respondents are either unable to do or find difficult to do (in both cases the response rate was higher than the England average). 30% of Solihull respondents to the survey indicated that they buy additional care or support with their own money with a further 10% saying that their family pays for this time of top up support. 63 Adult Social Care Performance The National Adult Social Care Intelligence Service (NASCIS) provides an array of analytical and information resources allowing effective and timely analysis of Social Care data to aid activities such as planning, performance management and service improvement. Some of Solihull’s key performance indicators relative to the England average and a group of comparator authorities8 are listed below. Achieving independence for older people through rehabilitation/intermediate care (expressed as a percentage), 2010‐11 Minimum 25th Percentile Average 75th Percentile Maximum Solihull 76 Comparator 63.4 75.6 80.9 85.2 97.1 England 44.9 78.5 83.1 88.8 100 Source: NASCIS Social care clients receiving self directed support (direct payments and individual budgets) 09/10 definition (expressed as a percentage), 2010‐11 Minimum 25th Percentile Average 75th Percentile Maximum Solihull 33.1 Comparator 10.6 21.8 27.8 32.8 43.5 England 4.0 22.1 30.1 35.2 98.5 Source: NASCIS Carers receiving needs assessment or review and a specific carer’s service, advice or information (expressed as a percentage), 2010‐11 th
Minimum 25 Percentile Average 75th Percentile Maximum Solihull 22.3 Comparator 10.2 19.6 26.6 33.3 38.3 England 8.4 22.3 28.7 33 60.2 Source: NASCIS Adults with learning disabilities in settled accommodation ie non‐institutional (expressed as a percentage), 2010‐11 Minimum 25th Percentile Average 75th Percentile Maximum Solihull 19.3 Comparator 19.3 40.2 52.7 62.6 80.8 England 19.3 51.5 60.6 70.2 100 Source: NASCIS 8
CIPFA comparator group: Bath & NE Somerset, Bedford, Bury, Central Bedfordshire, Cheshire East, Cheshire West & Chester, North Somerset, Poole, South Gloucestershire, Stockport, Swindon, Trafford, Warrington, Wiltshire, York. 64 Adults in contact with secondary mental health services [BSMHT] in settled accommodation (expressed as a percentage), 2010‐11 Minimum 25th Percentile Average 75th Percentile Maximum Solihull 66.9 Comparator 5.8 75.7 76 84.8 92.8 England 0 60.4 66.6 79.6 92.8 Source: NASCIS Adults with learning disabilities in employment (expressed as a percentage), 2010‐11 Minimum 25th Percentile Average 75th Percentile Maximum Solihull 2.4 Comparator 2.2 4.7 6.8 8.2 13.6 England 0 4.1 7.1 9.0 30.8 Source: NASCIS Adults in contact with secondary mental health services [BSMHT] in employment (expressed as a percentage), 2010‐11 Minimum 25th Percentile Average 75th Percentile Maximum Solihull 15 Comparator 5.7 12.1 14.2 16.3 28.7 England 0 5.6 9 12.2 28.7 Source: NASCIS Costs NASCIS provides a client type breakdown of gross current expenditure on adult social service by Solihull Council relative to our benchmark group of local authorities and the national average. One of the main features of this analysis is that Solihull spends proportionately far more on adults (aged 16‐
64 years) with a learning difficulty (34% of total expenditure) than either the comparator group average (25%) or the England average (25%). Solihull’s position from the NASCIS Use of Resources report for 2010‐11 can be summarised into the following table (note that the figures are the rank of the proportion of gross current expenditure compared with all Metropolitan authorities where 1 is the highest [worst] and 36 the lowest): Client Type Adults Older People Physical Disability Learning Disabilities Mental Health Needs All Assessment & Care Management Day & Domiciliary Care Nursing & Residential Care 29
20
2
33
13
14
6
35
23
31
5 34 34 3 ‐ Note that Mental Health is a joint service in Solihull with many clients being recorded on health systems The above table suggests that although spend on Learning Disabilities may be offset to some extent by the mix between permanent and non‐institutional care, the variance that Solihull exhibits for the 65 client group with comparators and England overall is clearly within the permanent setting. There are some historic reasons (incorporation of LD hospitals) for this but it should be noted that Learning Disabilities social care packages account for approximately 90 of the top 100 packages by annualised cost whilst only accounting for a fifth of all social care packages. It is notable that the average age for the most expensive 20 LD clients is around 35 which is at least 10 years less than the average for the 90 highlighted above, suggesting that this is a long‐term problem as well. Service Developments Solihull’s Local Account for 2011 (which becomes a statutory requirement for all Local Authorities from 2012) provides a detailed view of the progress that the Council is making in transforming and improving Adult Social Care, with insight in to how these changes will impact on specific client groups. However, it is worth highlighting some of the strategic changes that are driving Putting Solihull People First: Personalisation means making sure that services are tailored to the needs of the individual rather than delivered in a one‐size‐fits‐all fashion. Since June 2010 we have been using a Personal Budget process with all new service users with an on‐going need for social care support. In August 2010 this was extended to all existing service users after their reviews. The service user can choose whether to manage this budget themselves as a Direct Payment or if they would prefer the Council can manage the budget on their behalf. In this way direct payments and personal budgets help to:  Ensure that people are able to design and choose the support or care arrangements that best suit their specific needs and fit with their own goals and lives;  Increase the opportunities for independence, improve self‐esteem and help people to be more involved in their community. By the end of the second quarter of 2011/12 more than 1,350 people in Solihull have gone through the Personal Budget process, with more than 500 people (including carers) in Solihull receiving a Direct Payment for their on‐going service. It is anticipated that another 200‐300 people will receive a one‐off Direct Payment during the remainder of the 2011‐12 financial year. In 2010/11 we exceeded the target for social care clients using self directed support (personal budgets and Direct Payments), and progress has continued during this financial year. The figure currently standing at 50%. Work is underway to review and make improvements to both the assessment questionnaire and resource allocation system for Personal Budgets, with objectives to:  Improve accuracy and efficiency;  Reduce bureaucracy;  Develop the role of self‐assessment within the assessment process for Adult Social Care;  Enable more people to access the benefits of using Direct Payments. Our rehabilitation and re‐ablement services provide timely and intensive interventions (six weeks in duration) which aim to: 66 



Help individuals with poor physical or mental health or a disability to learn or re‐learn the skills necessary for daily living; Maximise the long‐term independence of those with care needs, by supporting care closer to home; Reduce future demand for adult social services; Lower the cost of care packages. Our re‐ablement services focus on individuals newly referred to our services, but can also be applied to existing service users who entered the system prior to its implementation. It is potentially applicable to all adults including specialist services for those with dementia (the Community Enablement and Recovery Team). One of the strengths of our service is that it draws on a range of skills including those of care staff, social workers and community occupational therapists (OTs) who are able to visit the person, identify the goals they wish to achieve and agree a programme of support. Throughout the period users are monitored and support can be reduced as goals are achieved, or changed to accommodate new goals. Over the last year we have been able to develop and expand our re‐ablement services by refocusing the in‐house domiciliary care service we provide onto re‐ablement provision. This has contributed to a number of successes in the last year including: 
A reduction in people receiving care after re‐ablement and where care packages are required after re‐ablement they are at a reduced numbers of hours; 
An improvement in staff satisfaction and retention. In order to develop our service we aim to: 
Increase capacity to enable more people to access service; 
Make greater use of Assistive Technology; 
Develop Reablement Assessors who will undertake initial assessments, work with individuals as they go through re‐ablement and support them through the personalisation process if on‐
going care is required; 
Develop our physiotherapy support; 
Enhance staff skills to enable them to work confidently across all client groups. Alongside our re‐ablement provision we have introduced a new Hospital Discharge Service (HDS) for individuals being discharged from hospital where re‐ablement capacity is not available. The HDS is free for a period of 21 days and allows individuals to remain at home while waiting for the re‐
ablement service to begin. We have also developed a short term residential assessment service for individuals who are ready to be discharged from hospital but who would not immediately benefit from re‐ablement or the HDS. The service has the support of OTs and physiotherapy input if any is needed. Placements are for a maximum of eight weeks (shorter if possible) with a discharge date set early in the process. Input from the re‐ablement service that enables the individual to return home with a re‐ablement package. 67 Providing Individuals with the Tools to Make Informed Health Care Choices The following section looks at some of the ways in which people (from children and young people to adults) can be supported to help themselves. Ensuring people have control over their lives can contribute to healthier lifestyle choices as well as in making decisions around other aspects of life such as housing issues and employment. Education School attainment at Key Stage 4 provides a useful benchmark for assessing the extent to which young people in Solihull are being prepared for adult life and have the necessary tools with which to maximise their potential and opportunities. From a health perspective there is also a clear link between attainment, health literacy and the types of choices made by adults in terms of their lifestyle. Key Stage 4 (KS4) is the legal term for the two years of school education which incorporate GCSEs, and other accredited examinations. At the end of this stage, pupils in Year 11 (usually aged 16) are normally entered for a range of external examinations. Most frequently, these are GCSE (General Certificate of Secondary Education) exams, although a range of other qualifications is growing in popularity, including NVQ National Vocational Qualifications. Performance at KS4 provides a useful overall barometer of educational attainment, as it is both backward looking, providing a measurement of progress throughout the school years and forward looking in the sense that it is a predictor of patterns in workforce skills. The gold standard for outcomes at secondary school is the proportion of pupils achieving 5 or more GCSEs or equivalent at grades A* ‐ C including English and Maths at the end of KS4. Solihull performs well on this measure with 61.3% of pupils achieving this standard in 2010/11 (provisional results) compared to 58.3% across England as a whole, ranking the Borough 34th out of 151 Local Authorities (second quintile). The proportion of pupils achieving 5 A* ‐ C grade GCSEs increased from 50.5% to 61.3% between 2005/06 and 2010/11, although the gap between the results in the borough and across England and the West Midlands have narrowed over this period. 68 However, this overall results masks significant variations at a school level, with the number of pupils achieving 5 or more A*‐C grade GCSEs in 2009/10 (latest figures) including English and Maths ranging from 92% (Arden) to 30% (Archbishop Grimshaw ‐ now John Henry Newman).
Pupils Achieving 5 or More A*‐C Grade GCSEs inc English & Maths
Solihull Average
90%
England Average
Proportion of pupils achieving
100%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Source: Department of Children, Schools & Families
A more detailed view of relative performance at KS4 is provided by analysing average KS4 scores among pupils resident in Solihull (school performance figures include results from pupils living outside the Borough who constitute around 20% of all pupils attending Solihull schools). The average score per Solihull resident pupil for the three school years 2006/7 to 2008/09 is 11% higher than 69 England as a whole9. However, within Solihull there is a clear divide with pupils living in the three north Solihull regeneration wards achieving an average KS4 score 27% below the rest of the Borough. All of the 25 LSOAs in the north Solihull regeneration wards have an average KS4 score below the national average, compared to just 15 out of 108 in the rest of the Borough (most notably Hobs Moat North, Ulverley East and Damsonwood South). Average KS4 Score
265.8 - 347.3
North Solihull Regeneration Wards
347.3 - 395.2
395.2 - 439.8
439.8 - 485.7
485.7 - 540.2
540.2 - 622.8
Hobs Moat North
Ulverley
East
Damsonwood
South
Source: Department for Children Schools & Families
In March 2011 43.1% of Looked After Children (LAC) at Solihull schools achieved at least 5 A*‐C GCSEs compared to the England average of 31.2% and the West Midlands average of 35.4%. Of the 102 Local Authorities in England reporting on this figure, Solihull had the 15th highest proportion of passes at this level among LAC (top quintile). Solihull also has an above average proportion of LAC achieving at least 5 A*‐C grade GCSEs including English & Maths (13.7% compared to 12.8% in England and 13.5% in the West Midlands). However, this also demonstrates the extent to which that there is an inequality gap between LAC and the overall school population (where around 60% of pupils achieve this standard). Another inequality in terms of educational attainment relates to the proportion of children with a Special Educational Need (SEN) achieving five good quality GCSEs compared to non‐SEN pupils. In academic year 2009/10 28% of pupils at a Solihull school achieved at least 5 A* ‐ C grade GCSEs including English & maths compared to 72% of non‐SEN pupils. The proportion of SEN pupils achieving this standard in Solihull is higher than the national average (22%) and at 44 percentage points the borough has the same proportional gap in inequality on this measure. As the chart below shows by ethnicity the smallest proportion of pupils achieving at least 5 A*‐C grade CGSEs including English & Maths are among pupils from a mixed race background (51%) and black pupils (54%). Although in both cases this is consistent with the pattern nationally. 9
ONS Neighbourhood Statistics 70 Health Literacy Health literacy is defined as the cognitive and social skills that determine the motivation and ability of individuals to gain access to understand and use information in ways that promote and maintain good health. It has been described in terms of three levels of skills, these are:  Functional health: Having the sufficient basic skills to function in everyday life;  Interactive health literacy: More advanced skills in interpreting information from different sources and balancing these in decision‐making; 
Critical health literacy: The application of skills and analysis of information to exert control and participate in managing own health and contributing to wider decision making.
There have been many studies examining the link between ‘health literacy’ and the effective prevention, diagnosis and treatment of many different health conditions10. This issue has been studied in different social groups in a wide range of countries. Generally, the research has found that low levels of literacy, language and numeracy (LLN) skills make it less likely that an individual will be able to navigate effectively the health care system to receive the preventative, curative and maintenance treatments, advice and information they require. These skills are seen as an essential health literacy tool. Limited LLN skills are thus intimately linked with limited health literacy. National research shows that England has low levels of basic general literacy and numeracy. The Skills for Life Survey showed that 46% of participants (equivalent to 17.8 million people in England) scored at a literacy level below that required to achieve their full potential, with 3% (1.1 million people) at the very lowest level, being functionally illiterate. The figures are even worse for numeracy with 75% (23.8 million people) scoring at a level below that required to achieve their full 10
Department of Health 71 potential with 5% (1.7 million people) being functionally innumerate. It is, therefore, very likely that levels of Health Literacy and Numeracy are similarly low, and that for many people low HL acts as a significant barrier to achieving and maintaining good health. As an example, recent research on 33‐year‐old adults in England has shown a strong correlation between indicators of poor health or unhealthy lifestyles and a poor experience of secondary education. When comparing those who were disengaged at school and had no GCSE qualifications and those who did, the odds of: 



smoking are 4.7 times higher for women and 3.5 times higher for men; drinking heavily are 1.5 times higher; taking exercise less than once a week are 1.5 times higher; having depression are 2.4 times higher for women and 2 times higher for men; having back pain are 1.3 times higher in men having migraines are 1.3 times higher in women. Estimates of the low level of health literacy in the UK have ranged from 11 to 19%11. It is argued that patients in a hospital setting have a lower ability to understand healthcare messages. A recent study suggests that over half of England’s adult population have literacy skills below the level needed to discuss a condition interactively with a doctor or specialist12. In addition, only one quarter were able to calculate body mass index with a formula or identify food groups needed for a balanced diet. There is no local data for levels of health literacy in Solihull. However, it is estimated13 that 14,710 adults in Solihull have entry level literacy skills only, equating to 11% of the adult population, below the England and West Midlands averages of 16% and 18% respectively. Wards in north Solihull all have more adults than the England average with basic literacy skills only, with Chelmsley Wood at 27% the highest. 11
Health Literacy is not Just Reading and Writing, Nicola Gray, Journal of Pharmacy (2009) Functional Health Literacy and Health Promoting Behaviour in British Adults, van Wagner et al, Journal of Epidemiology and Community Health (2007) 13
Department for Business, Innovation & Skills 12
72 Proportion of Adults With Entry Level Literacy Skills
Proportion of Adult Population
30%
Solihull
England
25%
20%
15%
10%
5%
0%
Source: Department for Business Innovation & Skills
An estimate 130,270 in Solihull have entry level numeracy skills only, equating to 48% of the adult population, marginally higher than the England and West Midlands averages of 47%. However, Solihull’s proportion of adults in the lowest category entry level 1 is at 2%, below the national average of 5.4%. Wards in north Solihull all have more adults than the England average with basic numeracy skills only (71% Fordbridge), as well as Castle Bromwich and Elmdon, Lyndon and Bickenhill in south Solihull. Proportion of Adults With Entry Level Numeracy Skills
Proportion of Adult Population
80%
70%
Solihull
England
60%
50%
40%
30%
20%
10%
0%
Source: Department for Business Innovation & Skills
73 Support Groups and Community Action Studies from the US note that not only does social isolation have a negative impact on general well‐
being but that there is also a direct link with poor health outcomes. For instance, the magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors14. Particular risk groups include, the elderly, the poor, and minorities. Individuals with existing health problems or a disability are also at risk of social isolation, with the Social Exclusion Unit (Office of the Deputy Prime Minister) noting that adults with mental health problems are one of the most excluded groups in society15. For all at risk social isolation can be a product of poor employment prospects, low levels of mobility and access, fear of crime and discrimination. In this respect, social networks and support groups are vital to the wellbeing of many people with a care need, helping prevent isolation and spreading information and guidance. The development of a weekly Memory Café run by the Alzheimer’s Society for people with dementia has been an outstanding success. It provides individuals with an opportunity to share their experiences of dementia and improve their self‐esteem, with a regular programme of events planned by the service users themselves. There are now cafés in north, west and central Solihull, as well as an informal network that helps carers prepare and adjust to their relative’s illness. Further plans include:  An additional café in central Solihull from December 2011;  A move to larger premises for the Solihull Lodge café to meet growing demand. Through the Learning Disability Development Fund (LDDF) we piloted a series of ‘Story Telling’ sessions where people with learning disabilities who live in residential care homes ‘tell their stories’. These sessions develop communication skills and will help those taking part to be more involved in making choices in important areas of their life such as health and housing. The success of this project has led to a similar series of sessions in 2011/12 for people with multiple disabilities. We have also secured funding for a film club, run by people with learning disabilities and supported by Solihull Action through Advocacy, for the local community in north Solihull. This will give people with learning disabilities the opportunity to contribute to the local community and enhance their quality of life. Community action also plays a key role in supporting people to help themselves and therefore in the wider preventative agenda. In Solihull the broad objective to empower local communities is especially relevant as the Partnership has already recognised that it is vital to ensure that public services are shaped by, and meet the needs of, all our communities. An engaged and empowered community is one which has the confidence and capacity to articulate its needs effectively and the enthusiasm to participate in both local democracy and volunteering projects. Furthermore, co‐production projects between 14
15
Social Isolation Kills, But How and Why? J.S. House, American Psychosomatic Society (2001) Mental Health and Social Isolation, Social Exclusion Unit (2004) 74 public sector bodies and the community can improve quality of life and the way local people perceive their area. To this end the Solihull Partnership has been piloting different approaches to community engagement through for example the Smiths Wood Area Neighbourhood Network (SWANN), Community Action in Fordbridge (CAFÉ), Chelmsley in Partnership (CHIP) and the Locals in Kingshurst (LinK). The SWANN project, which is working with local service providers to tackle issues (the environment, community safety, community facilities, regeneration and transport) identified by residents at a listening event, has been instrumental in developing a framework of critical success factors for community engagement, including: 
Building relationships and trust between local residents and local service providers; 
Being locally responsive (e.g. tackling the things that people are saying are important); 
Securing some early wins so that people can see something positive happening which will encourage more people to join in; 
Providing appropriate support and skills training to enable residents to grow in confidence and capacity.
In addition the North Solihull Regeneration Partnership is providing funding to 12 projects which are currently operational during financial year during 2011/12 which address community development, economic well‐being, open space and health. 









Community Capacity Building Training Programme: Delivery of a programme of training sessions to community organisations.
Resident Led Group in Chelmsley Wood: Development of a resident led partnership to identify and tackle residents concerns in Chelmsley Wood.
Resident Led Group in Kingshurst: Development of a resident led partnership to identify and tackle residents concerns in Kingshurst.
Construction Manager : Development of relationships to maximise employment opportunities for residents of North Solihull.
Employment Development: Identification of gaps in employment support provision, forging of links with local employment support providers and identification of opportunities for new projects and joint working.
Young Enterprise Company Programme: Delivery of a Young Enterprise Scheme within schools of North Solihull.
Multi‐agency Outreach Service: Provision of a “one stop shop” for residents to seek information and advice on matters relating to: money, employment, training and support for parents. From Jan ’12 this will also include Benefit Advice.
Kingshurst Arts Parade: Development of a unit on Kingshurst Parade into a community hub, which uses art as the tool for reaching out to people.
Living Roots: 12 month detached youth project engaging young people at risk from the North Solihull area, introducing them to a wide range of skills relating to conservation, art, media production and youth work.
Shaping Sport in North Solihull: Appointment of a School Sports Organiser Project to develop opportunities for children and families to access sport, games and health related fitness opportunities.
75 
Active Women: Breakdown of barriers to women and girls (aged between 16 – 25) participating in doorstep sport and physical activity. 
Baby Think it Over: Series of 10 week programmes informing young people aged 15 – 19yrs about sexual health, relationships and the realities of being a parent. Information and Access to Services Providing individuals with care needs and their carers with easy access to the services they need and information about their condition In order to improve access to services Solihull Council launched a ‘One Front Door’ phone number to provide anyone new to adult social care with general information, including services provided by partner organisations, as well as referrals and access into services. From August 2011 the service also became responsible for the handling of adult safeguarding calls. Early performance results indicate that the service receives approximately 400 calls per month, with 97% of calls answered. The Council also continues to work with Partners in developing user support groups, which help deliver information to those with a care need and carers and help raise awareness. Alongside the “One Front Door” helpline we are pursuing a number of initiatives to ensure that all individuals with a care need are referred to an appropriate service. Our approach of using existing community assets and partners to improve access into specialist services is proving to be an effective and inclusive innovation across a range of client groups. For instance, the Solihull Healthy Minds service is now being delivered from all Solihull GP Practices as well as community venues such as the Bosworth Centre, the Renewal Family Centre and Sheldon Fire Station to ensure that people can be treated close to home in reassuring settings. Ideally people will want to see their GP first who will then advise of the most appropriate intervention to support their needs, but for people who may find this difficult we are establishing drop in services to support self referral. We are also conscious of the benefits of creating a more co‐ordinated single point of entry into some of our services. For instance, our Helping Young People Early (HYPE) team recently won the West Midlands Transforming Community Services Leadership Challenge for ‘No Wrong Door’, a proposal for a single point of access for young people into mental health services. A partnership approach will ensure that each individual needing care will be identified, assessed and referred to an appropriate service, no matter where they enter the system. To progress this initiative we have appointed a Project manager who is working with partners to develop the HYPE concept into a robust service model for consultation. We are also working to ensure that we reach hard to reach groups. For instance, our strategy for adults with learning difficulties places significant emphasis on providing equal access to healthcare for this client group and we can report good progress in this area. We have created a small team of learning disability nurses who help professionals in primary and secondary care meet the needs of patients who have learning disabilities. This has been extremely effective in managing the admission and treatment of some people with very complex needs; in 76 some cases it has ensured that people who are unable to use words to communicate their needs have received crucial treatment. We have also ensured that all individuals in Solihull known to have a learning disability are registered with a GP, with the guarantee of an annual health check. This is a very practical and effective way of beginning to address the significant health inequalities experienced by this group of people. Similarly, the Solihull Healthy Minds service is constantly evolving to improve the access, range and coverage of psychological support for the people of Solihull, with a particular emphasis on older people and young people. For instance, Age UK is helping us to improve access for the over 50s by providing accommodation for a drop in clinic once a month and advertising these sessions throughout their organisation. Also of relevance; the Solihull Care Directory (www.solihullcaredirectory.co.uk) is a web based directory of social care services operating in the borough. The Directory was developed by Adult Social Care in partnership with the voluntary and community sector (via Enable Solihull who administer the directory). It helps people to search for relevant services and lists over 200 services ranging from residential care homes, to information and advice services. It is a valuable resource to people with social care needs, their families and carers and to professionals working with them to help plan their support. It’s an example of how information and advice is evolving to meet the needs of people using Personal Budgets and opting to direct their own support. Priorities for Commissioning •
Continue to prioritise reducing inequalities in educational outcomes; •
Support schools, families and communities to work in partnership to improve educational outcomes, health and wellbeing; •
Increase access and use of quality lifelong learning opportunities; •
A radical shift in service provision for older people, to respond to future health, social and demographic trends; •
Supporting people to live independently and the development of community services as an alternative to institutional care; •
Enabling people to have more choice and control over the care and support that is received; •
Improvements will be required in care management and assessment; provision of intensive home support; intermediate care; and re‐ablement; •
Services to support and care for people with dementia will become increasingly important; •
Development of services to support carers, based on an assessment of their needs. 77 CreateFairEmploymentandGood
WorkForAll
Key Findings •
Solihull’s economy is strong, but has contracted by 2.6% since 2008; •
Economy is dominated by knowledge‐intensive (58%), high level occupations (49%) and high skill based sectors; •
Worklessness at 10.6% (11.9%) and unemployment at 3.8% (3.8%) is comparatively low (2011); •
Worklessness is comprised of people claiming unemployment, incapacity, lone parents, and other income related benefits; •
Long term worklessness – 60% over 1 year and 36% over 5 years; •
Inequalities exist in access to employment: •
Geography (49% in North Solihull); •
Young people (10% aged 18‐24yrs; doubled over last 2 yrs); •
Lower skilled workers; •
Ill health and disability; •
Lone parents; •
Ex‐offenders. •
Mental ill health (43%) and MSK disorders (17%) are the main causes of claim for incapacity benefit; •
Health at Work Programmes: least well developed in public sector and Small/Medium Enterprises. Employment and Health National research shows that being out of work can have a detrimental effect on an individuals physical and mental health and wellbeing. In turn poor health and disability can prevent individuals from gaining secure and stable employment. Unemployment is a significant risk factor for a number of health indicators1. The effects can be linked to poverty and low income amongst the unemployed. There are also significant psychological 1
London Health Observatory 78 consequences from being out of work, especially for the long term unemployed. In addition, work can play an important role in individual’s social networks and participation in society.
Unemployed people are found to have: 
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Lower levels of psychological well‐being which may range from symptoms of depression and anxiety through to self harm and suicide (three‐quarters are men). Higher rates of morbidity ‐ such as limiting long term illness. Higher rates of premature mortality, in particular for coronary heart disease and injuries and poisoning including suicide. There is also the effect that people with poorer health are more likely to be unemployed ‐ this is particularly true for people with long term disabilities. However, this does not explain the finding of poorer health amongst the unemployed. It is thought that the ways that unemployment lead to poorer health include: 
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Effects of increased poverty and material deprivation. These can be particularly acute for people in manual occupations, who tend to be on lower incomes anyway. Social exclusion, isolation and stigma. Changes in health related behaviour. Disruption to longer term careers. Policies that increase the supply of jobs and participation in employment are therefore likely to have a significant health benefit for individuals and for the local community. For people in paid employment, there are certain aspects of work that can affect health. Over the past few years the issue of job security has been recognised as important for well‐being. The long‐
term trend in the economy towards less secure, short term employment affects most of us, but is especially important for less skilled manual workers. A number of studies have shown how having a greater degree of control over our work is associated with positive health benefits, lower coronary heart disease, musculoskeletal disorders, less mental illness and fewer episodes of sickness absence. Amongst the most famous examples are the series of studies of civil servants in Whitehall ‐ all people in paid relatively secure work ‐ yet for whom there are significant and enduring health gradients associating the lower income groups with the worst health. Local Economic Conditions and the Supply of Jobs Since the 1990s, Solihull has been a focal point for economic growth in the West Midlands, as the location for Birmingham Airport, the NEC, Jaguar Land Rover and Birmingham and Blythe Valley Business Parks, and reflecting the development of Solihull Town Centre and the quality of the Borough’s investment offer including its central location, excellent transport connectivity, high standard of environment and other quality of life assets and access to a well‐qualified labour force. These strengths have enabled Solihull to grow its business and employment base substantially, with 6,615 businesses equating to a relatively high business density of 321 businesses per 10,000 population and a relatively high job density with 92,600 jobs equating to 0.72 jobs per working age 79 adult ‐ higher than both the England (0.67) and West Midlands (0.66) averages. Although it is significant to note that the North Solihull Regeneration area is less economically developed than the south of the borough and job density is much lower at 0.38 jobs per working age adult. In particular, Solihull has been successful in attracting businesses operating in high value‐added, knowledge‐intensive sectors – particularly business and financial services, ICT, construction and automotive manufacturing. Compared to 53% nationally and 52% regionally, 58% of jobs in Solihull are in sectors classified as knowledge intensive and in 2008 Solihull had the 11th best performing sub‐regional economy in England in terms of economic output per hour worked (exceeding the UK average by 8%). In particular, Solihull has a relatively high proportion of jobs in sectors of the economy that are expanding and are expected at a national and regional level to drive growth in the economy, including: o Tourism, leisure and retail (25% compared to 24% nationally and 24% regionally); o Finance and business services (20% compared to 21% nationally and 17% regionally); o ICT (6.4% compared to 4% nationally and 3.4% regionally); o Transport manufacturing (6.7% compared to 1% nationally and 2.6% regionally?). The recession has had a negative impact on Solihull’s economy as elsewhere, with the Borough experiencing a net contraction of ‐2.6% in the number of businesses between 2008 and 2010, (exceeding contractions of ‐1.7% in England and ‐1.2% in the West Midlands), and a net contraction of employment of ‐4.2% (‐4,000 jobs) compared to ‐4.5% regionally and ‐3% nationally. Employment contraction in Solihull was greatest in the construction sector (‐40%), followed by finance and business services (‐14%), production (‐9%) and retail (‐4%). Only the public sector (+10%) and the transport, storage and communications (+9%) sectors experienced an increase in job numbers. The tourism sector was also a key sector of employment growth over this period, with hotel investment in particular delivering a net increase of 2,000 jobs. Encouragingly, Solihull’s economy seems to have recovered more quickly than the national and regional average in terms of the supply of jobs, experiencing a net expansion of employment between 2009 and 2010 of +2.7% compared to a national contraction of ‐0.2% and a more modest regional average increase of +0.8%. Furthermore, as of November, job vacancy levels notified to Jobcentre Plus in Solihull are up on pre‐recession levels by +2%. That is, labour demand in Solihull appears to be relatively resilient and may reflect its balance towards growth sectors and a relatively low reliance on public sector employment (27% of jobs are in the public sector compared to 33% nationally and 34% regionally). In fact the public sector delivered the highest percentage increase in job numbers of any sector in Solihull between 2008 and 2010 at +10%. Other positive signs of recovery are an apparent recovery in levels of new investment into the Borough in 2011/12 – at least to 2006/07 levels (2007/08 was an exceptional year in terms of levels of new investment recorded by the Council). The ICT sector in particular continues to invest strongly in Solihull, representing 20% of new investments over the period 2009/10 to 2010/11. Investment in the retail and wholesale sectors also seems to be holding up comparatively well – accounting for 13% of investments over this period. 80 Furthermore, whilst conditions for new enterprise significantly worsened as a result of the downturn in Solihull, with the number of business failures exceeding the number of business starts in 2009 for the first time, Solihull continues to offer an environment in which new businesses can survive, with 83% of enterprises started in Solihull in 2007 still active in 2009 compared to the national average of 81%. However, more negatively, small business growth rates in Solihull have been below national and regional average rates – with on average 11.1% of small businesses in Solihull demonstrating employment growth between 2002/03 and 2007/08 compared to 12.6% across the West Midlands and 12.5% across England. Based on its strengths, Solihull, and particularly the ‘M42 Economic Gateway’ area encompassing the above assets and the location of the proposed High Speed Rail station, has the potential to deliver significant levels of additional economic growth and employment and to play a leading role in the West Midlands’ economic recovery. Supply of Jobs and Resident Employment In considering job creation and resident employment, it is necessary to acknowledge the wider travel to work area for Solihull residents, which extends beyond the Borough’s boundaries, and the accessibility of employment opportunities to residents. With regards to the geography of employment opportunities, the 2010 Local Economic Assessment identified that Solihull has particularly strong commuting links with Birmingham, with over a third of Solihull residents commuting to Birmingham for work at the time of the 2001 Census. Significant commuting links also existed with Coventry, Warwickshire, southern Staffordshire, northern Worcestershire and the Black Country. The assessment noted that extent of an individuals’ travel to work area tends to relate to their occupational profile, with managerial and professional workers more likely to travel further for work than those working in elementary or plant, process and machine operative occupations. The assessment also noted that, at the time of the 2001 Census, residents of the ‘North Solihull’ regeneration area were more likely to work in Birmingham than in Solihull, and were more likely to work in the Black Country or North Warwickshire than in Solihull Town Centre. As regards the accessibility of employment opportunities to residents it is necessary to consider a range of issues – particularly the extent to which the nature of the employment opportunities existing in the labour market reflect resident skills levels. The 2010 Local Economic Assessment noted that the supply of jobs in Solihull is skewed towards higher level occupations, with nearly half of all jobs (49%) at managerial, senior official, professional, associate professional or technical level ‐ higher than averages of 47% for the South East, 46% for England and 43% for the West Midlands. Conversely, a relatively small proportion of jobs in Solihull are in occupations requiring lower qualification levels – particularly skilled trades (6.6%) and administrative and secretarial (10.4%) occupations, but also elementary (10.8%) and plant, process and machine operative (5.1%) occupations. However, Solihull’s working age population is relatively well‐qualified, with over half (54%) qualified to NVQ3 level or above (compared to 51% nationally and 45% regionally) and 33% qualified to NVQ4 level or above (compared to 31% nationally and 26% regionally). Following on from this, at the time 81 of the 2010 assessment, a higher than average proportion of residents (50.3%) were employed in managerial, senior official, professional, associate professional or technical occupations compared to 47.9% across the South East, 44.2% across England and 40.3% across the West Midlands. It was estimated that a significant proportion of these residents work outside the Borough (36% of professionally‐employed residents and 28% of associated professional or technical workers). However, nearly a quarter (24%) of the working age population are only qualified to NVQ1 level or below (compared to 24% nationally and 30% regionally) and 10% of working age residents have no formal qualifications (compared to 11% nationally and 15% regionally). Adults aged 25 to 54 with low qualifications (maximum NVQ1 level) tend to live in the ‘North Solihull’ regeneration area, Parkfields in Castle Bromwich or in parts of Elmdon, Lyndon and Shirley. Low qualification attainment is increasingly significant as a barrier to employment as the economy trends towards increased demand for qualifications, reflecting the shift towards a knowledge‐
intensive service based economy. Furthermore, in times of economic slow‐down and subdued labour demand, lower qualified workers are likely to experience greater barriers in accessing employment in the face of greater competition from more highly qualified workers. These factors point towards the need for a multi‐stranded employment policy encompassing action to ensure a diversity of employment opportunities in the local economy, including entry‐level opportunities and opportunities requiring lower qualification levels, as well as action to increase workforce skills levels in line with changing opportunities in the labour market and employer demand. Whilst Solihull has demonstrated strengths in attracting investment in sectors relying heavily on a highly qualified workforce (e.g. ICT, business and professional services), the Borough also has a strong employment base in automotive manufacturing and tourism, leisure and retail – the latter in particular tending to offer a relatively high proportion of entry level opportunities and opportunities requiring lower qualification levels. In particular, the Resorts World development proposals at the NEC including a large casino proposal are expected to generate over 1,000 new operational jobs, the majority of which are expected to be suitable for 18 to 24 year olds. Further growth at the Airport, the HS2 proposals and additional town centre development opportunities, particularly in Solihull and Shirley Town Centres, can also be expected to generate additional tourism, leisure and retail sector opportunities. A key strand of local and sub‐regional policy, working with the other partners in the Greater Birmingham and Solihull Local Enterprise Partnership, is to ensure that education, training, careers advice and employment support provision is more effectively aligned with the future needs of the economy and changing employer requirements. Employment Participation and Worklessness Profile The number of people in Solihull who are not in employment has increased significantly since the recession (beginning in early 2008) and its aftermath. This is most obviously apparent in the increase of +87.5% in the numbers of Job Seekers Allowance claimants in the borough between April 2008 and December 2011, but is also evident in other measures of labour market participation. This 82 section sets out the impact that the recession and its aftermath has had on the Solihull labour market and employment in the borough. Compared with the England average a smaller proportion of Solihull residents of working age (16‐64) are economically active and in employment with more economically inactive, although the borough has proportionally fewer people unemployed than the West Midlands as a whole. Solihull England West Midlands Number (16‐64) Proportion Proportion Proportion Economically Active 93,500 74.0% 76.4% 74.2% Economically Inactive 32,800 26.0% 23.6% 25.8% In Employment 86,000 68.1% 70.4% 67.5% Unemployed 7,500 5.9% 5.9% 6.7% Source: Annual Population Survey Relatively weak and uneven labour demand, arising out of the recession and its aftermath has impacted on the extent to which Solihull residents are actively participating in the labour market. Between December 2008 and 2010 the economic inactivity rate in Solihull increased from 22.4% to 26%, with significant (and above average) increases in the numbers inactive due to long‐term sickness (+46%), taking part in full‐time education (+30%) or looking after the family/home (+24%). The increases in those in full‐time education or looking after family/home appear to be directly linked to labour market conditions as they offer alternatives to low paid employment or unemployment. This is supported by the fact that an increasing proportion of those classified as economically inactive in Solihull are looking for work and are have therefore chosen an alternative to employment out of necessity rather than choice (from 16% to 24% of the inactive total). Another significant consequence of the recession has been an increase in under‐employment; individuals working fewer hours than they would like. This can have a significant impact on household finances, increasing the risk of individuals falling into poverty. Evidence of under‐
employment is more readily available on a national rather than local basis. Official statistics2 show that in Q1 2011 the number of people working part‐time because they can’t find a full‐time job is at 1.18 million higher than at any point since records began in 1992 and now represents 15% of all part‐time employees. This represents an increase of 61% since the equivalent period in 2008 (i.e. since start of the recession). A report by the Office for National Statistics3 shows this measure under‐estimates the full extent of underemployment in the UK economy, as it does not account for those in full‐time positions who are working for fewer hours than they want. Analysis of Labour Force Survey data suggests that around 2.8 million people are subject to under‐employment, equating to a rate of 9.9% of total employment. 2
Labour Market Statistics, ONS Underemployment in the UK Labour Market, Annette Walling and Gareth Clancy, Office for National Statistics, February 2010 3
83 Locally evidence of under‐employment is relatively limited. The number of people working part‐time increased by 13% between December 2009 and December 2010 (Annual Population Survey), compared to a decrease of 1.6% in full‐time employees, although there is little evidence to suggest that this is a long‐term structural shift. There has however, been an increase in the proportion of people working less than 10 hours and from 10 to 34 hours at the expense of those working over 35 hours evident since 2007, which is consistent with the national trend in under‐employment. Solihull has a below England average level of worklessness4, although local data shows a more complex pattern with relative disadvantage evident among some population groups such as young people and at a neighbourhood level (e.g. North Solihull Regeneration area). There were 13,570 people in Solihull claiming an out of work benefit in February 2011, equating to a worklessness rate of 10.6%, compared to the England average of 11.9% and the West Midlands average of 13.7%. With the exception of jobseekers Solihull has a below average claimant rate for each of the components of the workless total.
Solihull Count Worklessness February 2011 Solihull Rate (%) England Rate (%) All Workless 13,570 Benefits ESA/Incapacity 6,490 Benefit Jobseekers 4,700 Lone Parents on 1,900 Income Support Others on Income 490 Related Benefit Source: Department of Work and Pensions West Midlands Rate (%) 10.6% 11.9% 13.7% 5.1% 6.2% 6.8% 3.7% 3.6% 4.6% 1.5% 1.6% 1.8% 0.4% 0.5% 0.6% A total of 8,030 individuals in Solihull have been claiming an out of work benefit for one year or more, equating to 60% of the total workless population, compared to 62% in England and 61% in the West Midlands. 4,750 individuals have been claiming for five years or more, equating to 36% of the total compared to 37% in England and 35% in the West Midlands. Long Term Out of Work Claimants in Solihull One Year + Count Proportion Five Years + Count Proportion All Workless Benefits 8,030 60% 4,750 36% ESA/Incapacity Benefit 5,590 86% 4,120 63% 700 15% 80 2% 1,420 77% 510 28% 67% 40 8% Jobseekers Lone Parents on Income Support Others on Income Related Benefit 320 Source: Department of Work and Pensions 4
Defined as individuals claiming an out of work benefit (Jobseekers Allowance, Employment Support Allowance/Incapacity Benefit, Lone Parents on Income Support, Other Income Related Benefits). 84 Similarly, claimant unemployment data shows that long-term unemployment lasting over 12
months in Solihull has increased by 3.6 times since April 2008 exceeding national and
regional rates of increase of 2.7 and 2.2 times. As of December 2011, long-term claimants
represent 18.5% of all claimants in Solihull compared to 18.4% nationally and 21.7%
regionally. Looking at ESA/Incapacity Benefit claimants in detail, there are 4,120 individuals in Solihull who have been claiming for five years or more, representing 63% of the total on these benefits, compared to 62% for both England and the West Midlands. A breakdown of incapacity benefit/severe disablement allowance payments shows that mental and behavioural disorders are the most common condition amongst claimants (2,150 individuals, 43% of the total), followed by Diseases of the musculoskeletal system and connective tissue (870, 17%). This is consistent with the pattern both nationally and regionally.
Worklessness increased as a result of the recession, with the following trends particularly significant: 
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The number of people claiming an out of work benefit in Solihull fell by 6.2% in the year to February 2011, slightly more than the England (‐4.2%) and West Midlands averages (‐5.4%). However, the number of Solihull claimants remains 14.7% higher than the recession baseline (May 2008), compared to the total increase over this period of 12% across both England and the West Midlands; The increase in the total number of workless residents in Solihull over the last four years is almost entirely attributable to the 98% increase in Job Seekers claimants between February 2008 and February 2009, compared to an increase of 77% in England and 70% in the West Midlands; The number of Solihull claimants of ESA or Incapacity benefit (which at 48% represents the largest component of the workless total) has fallen by ‐4% since February 2008 compared to no change for England and ‐1% for the West Midlands; Within Solihull there are clear spatial concentrations of worklessness. In February 2011 49% of out of work benefit claimants lived in the North Solihull regeneration area (6,705 individuals) where the workless rate is 24% compared to 6.7% in the rest of the Borough. The concentrations by individual benefit type are: 
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53% of jobseekers are resident in North Solihull, where the rate is 8.9% compared to 2.2% in the rest of the borough; 43% of ESA/IB claimants live in North Solihull (rate 10% compared to 3.7%); 62% of Lone Parents on Income Support (rate 4.2% compared to 0.7%); 49% of others on income related benefits (rate 0.9% compared to 0.3%). 85 Alongside the North Solihull Regeneration Area there are a number of LSOA neighbourhoods, mainly in the Lyndon, Olton and Shirley wards, where worklessness rates are relatively high. These pockets coincide with neighbourhoods identified by the Index of Multiple Deprivation as being relatively deprived in the context of the borough. Collectively, 135 LSOA include 26% of all claimants outside of the North Solihull regeneration area an average rate of 14.5%. Alongside deprivation there are some significant employment inequalities that effect specific population groups including young people, individuals from a Black and Minority Ethnic (BAME) background and the disabled. Analysis of claimant unemployment shows that, in common with the picture nationally, 18‐24 year olds have the highest rate of any age group (10.6%) and are the only age group in the borough with a rate higher than either than national or regional comparators (7.7% in England and 10.1% in the West Midlands). The rate for those aged 25 to 49 years (3.6%) and 50‐64 years (1.8%) in Solihull are lower than the national and regional averages. 5
Ulverley East, Hobs Moat North, Coventry Road East [Lyndon], Green Hill, Stratford Road South East [Shirley East], Damsonwood North, Damsonwood South, Hermitage [Silhill], Cranmore South [Shirley South], Marston Green [Bickenhill], Olton South [Olton], Solihull Lodge [Shirley West] and Parkfields [Castle Bromwich] 86 Solihull’s youth unemployment rate has been higher than the national rate since 2006, but has come to exceed the regional rate since the economic downturn, with the number of young claimants doubling between February 2008 and November 2011, above regional and national increases of +68% and +80%. It should also be noted that the increase in the number of 18‐24 year old claimants in Solihull over this period has been higher than for other broad age groups. 480 18‐24 year olds in Solihull have been claiming JSA for more than six months. This is 27% of all claimants aged 18‐24 years, compared to 24% in England and 28% in the West Midlands. Since the 87 February 2008 baseline 18‐24 year have accounted for an increasing proportion of all claimants claiming for more than six months in Solihull (from 17% in February 2008 to 27% in August 2011). The latest data from the Annual Population Survey from March 2011 shows that the unemployment rate6 among Solihull residents from a Black and Minority Ethnic (BAME) background is at 13.4% nearly double the rate among white residents (6.9%). However, this pattern of inequality is consistent with both England and the West Midlands and the BAME rate in Solihull is lower than the regional average (16.2%) and only slightly higher than the national (12.9%). No local data is available for different ethnic groups, although nationally and regionally rates are highest among individuals from a Black or Black British and Pakistani/Bangladeshi background. Within Solihull 54% of disabled people (aged 16‐64) are classified as economically active compared to 80% of non‐disabled adults. The employment rate is also below that for the non‐disabled population (47% compared to 75%). As a result, at 12%, the unemployment rate (Proportion of those economically active) is higher amongst disabled residents than among non‐disabled (7%). In this respect, the significantly higher levels of both economic inactivity and unemployment among disabled people in Solihull are consistent with national and regional patterns. It should be noted that employment participation varies with extent of disability. For instance, the employment rate in Solihull for individuals classified as DDA only disabled is 77% (above that for the non‐disabled population 75%), whereas among those classified as work limiting only disabled it is 61% and those classified as both DDA & work limiting disabled it is just 30%. 6
ILO definition for 16+ population 88 Worklessness Drivers and Barriers to Employment
The Local Economic Assessment notes that tackling “worklessness” and low household incomes requires an integrated response to the drivers or causes of “worklessness”. This section reviews some of the key barriers to employment and some of the population groups that face the greatest challenges in terms of accessing jobs. Respondents to a 2010 survey of local businesses were asked about their willingness to recruit groups who tend to be disadvantaged in the labour market. Half or more respondents said that they would recruit older people and lone parents. Just under half of respondents said that they would recruit long‐term unemployed people and people on incapacity benefit. However, lower proportions of respondents said that they would recruit people with disabilities (19%), people with learning difficulties (26%) and ex‐offenders (26%). Lower Skilled Individuals Restructuring in the UK economy (and in Solihull) has resulted in fewer jobs in elementary and relatively low skilled manual jobs, with knowledge intensive industries being the prime driver of both economic growth and future employment growth. The importance of skills is vital in ensuring Solihull has a labour pool that will continue to attract businesses and in ensuring that individuals are able to access the employment opportunities that are available locally. Individuals with lower skills are at an increasing disadvantage in the labour market and are significantly more likely to be either unemployed or in insecure or low paid employment. A recent report by the Centre for Cities7 notes that the shift towards a knowledge‐intensive service based economy has increased employer demand for qualifications and skills, reducing the number and share of lower skilled, entry‐level jobs. At the same time the geography of jobs is changing. While higher skilled jobs are increasingly concentrating in cities, along the main transport corridors and in city centres, lower skilled jobs are dispersing out of city centres. The geographical shift in the location of lower skilled jobs is particularly significant as those with lower skilled are often less mobile than those with higher skills and face a number of barriers in respect of access to jobs. These can include individual characteristics such as caring responsibilities and access to a car. The availability and cost of public transport is also critical as the financial benefits of working can easily be eroded for those in lower paid employment (i.e. the cost of transport can make it more economic not to work). Solihull has a relatively strong skills profile, with a significant proportion of residents qualified to at least NVQ level 3 and a relatively small proportion of residents with no or low skills notable features. 54% of Solihull’s working age population are qualified to at least NVQ 3 level compared to 51% for England and 45% for the West Midlands. The proportion qualified to at least NVQ 4 (degree level) is also above average (33% compared to 31% for England and 26% for the West Midlands). 7
Moving on Up, Moving on Out? Overcoming the Jobs‐Skills Mismatch, Centre for Cities (2011) 89 Just 10% of Solihull residents of working age have no qualifications (compared to 11% for England and 15% for the West Midlands), with the proportion qualified to a maximum NVQ1 (categorised as low skilled) also slightly below average (24% compared to 24% for England and 30% for the West Midlands). The link between worklessness and deprivation evident from the relatively high rates in the North Solihull regeneration area and pockets of the south of the borough, is, at least in part, a consequence of the lower level of skills among working age adults in these areas. This is shown by the difference in the skills profile of those in employment and those who are unemployed. 59% of those in employment are qualified to at least NVQ level 3 compared to 27% of those unemployed. Similarly, just 17% of those in employment are qualified to a maximum level of NVQ 1 (defined as low skilled) compared to 31% of those unemployed. Young People Young people are particularly vulnerable during a recession, along with other groups disadvantaged in the labour market, given their greater likelihood of low levels of work experience. The labour market becomes more competitive, making young people less attractive compared to more experienced applicants and as employers tend to contract their demand for entry level positions. In this scenario young graduates are more likely to find themselves underemployed, having to lower their job and wage expectations. This is evident in Solihull; a recent survey of 282 young
claimants in Solihull8 identified that, whilst low qualifications are common amongst young
claimants (31% were qualified to a maximum of Level 1 and 10% have no qualifications), a
significant proportion of young claimants are qualified to degree level or above (24% of 21 to
24 year-old claimants surveyed). Young people without qualifications are even more 8
SMBC, September 2011
90 disadvantaged, as even the most basic entry‐level jobs become harder to get. However, youth unemployment has been much higher than adult unemployment for some time and cannot be attributed solely to the impact of the recession. The long‐term nature of youth unemployment suggests that non‐recession factors underpin youth unemployment. The most important of these factors are:  Globalisation, which has resulted in labour intensive industries moving to less developed countries where labour is cheaper  A skills mismatch, including the fact that many young people leave the education system ill‐
equipped for jobs in the new economy.
Youth unemployment is argued9 to be more serious than adult unemployment for several economic reasons:  Scarring: Scarring is a causal link between unemployment history and a negative future experience in the labour market. It includes long‐term outcomes such as: lower wages; underemployment, and; low‐pay no‐pay cycles. This results in lost productivity over a lifetime.  Inactivity: High youth unemployment or underemployment may discourage young people from investing in education and training as it does not necessarily translate into better labour market outcomes.
Ensuring that young people have appropriate levels of qualifications and have the right skills for to meet the future demands of local businesses are critical in ensuring that young people are able to access jobs. In Solihull, measures of educational attainment indicate that young people in the borough are relatively well prepared for the labour market. For instance, in 2009/10 60.1% of pupils at school in Solihull achieved at least 5 A* to C grade GCSEs including English and Mathematics compared to 53.5% across England as a whole, ranking the Borough 31st out of 151 Local Authorities (top quintile). However, this overall results masks significant variations at a school level, with the number of pupils achieving 5 or more A*‐C grade GCSEs including English and Maths ranging from 92% (Arden) to 30% (Archbishop Grimshaw). A more detailed view of relative performance at KS4 is provided by analysing average KS4 scores among pupils resident in Solihull (school performance figures include results from pupils living outside the Borough who constitute around 20% of all pupils attending Solihull schools). The average score per Solihull resident pupil for the three school years 2006/7 to 2008/09 is 11% higher than England as a whole10. However, within Solihull there is a clear divide with pupils living in the three north Solihull regeneration wards achieving an average KS4 score 27% below the rest of the Borough. All of the 25 LSOAs in the north Solihull regeneration wards have an average KS4 score below the national average, compared to just 15 out of 108 in the rest of the Borough (most notably Hobs Moat North, Ulverley East and Damsonwood South).
9
Sticking Plaster of Stepping‐Stone? Tackling Urban Youth Unemployment, Centre for Cities (2009) ONS Neighbourhood Statistics 10
91 Average KS4 Score
265.8 - 347.3
North Solihull Regeneration Wards
347.3 - 395.2
395.2 - 439.8
439.8 - 485.7
485.7 - 540.2
540.2 - 622.8
Hobs Moat North
Ulverley
East
Damsonwood
South
Source: Department for Children Schools & Families
This geographical divide in educational attainment is mirrored by patterns in young people NEET11; the NEET rate in the three North Solihull regeneration wards is around 1.4 times higher than the borough average. Despite relatively strong overall performance at Solihull schools and relatively high levels of participation in Further and Higher education, there are some challenges in ensuring that young people in the borough are adequately prepared for the labour market. A recent survey of local 11
Not in Education, Employment or Training 92 employers showed that, although 39% of respondents thought that school pupils were inadequately prepared for work, a low proportion of respondents to the local survey identified that they currently offered opportunities for young people, with 6% offering apprenticeships, 8% offering work placements, 4% offering internships for college students and 1% offering sponsorship for university students. Poor preparation for employment amongst young people has emerged as a theme in a range of national research with business and has highlighted the importance of developing work‐
related learning opportunities and vocational routes to employment, including apprenticeships.
Alongside the need to ensure that young people are adequately prepared for the labour market, the Local Economic Assessment notes that there is a need to address low levels of educational attainment at Key Stage 4, and lower rates of participation in further and education amongst school leavers in parts of the Borough such as North Solihull. In fact at a borough level even though Solihull has a lower proportion of 16‐19 year olds qualified to a maximum level of NVQ1 (31% compared to 33% for England12), the borough has proportionally more low skilled 20‐24 year olds than nationally (26% qualified to maximum NVQ1 compared to 20% for England). Lone Parents Government reforms are seeking to get more lone parents into work, with single parents now required to seek work by the time their youngest child turns seven, down from age 16 in 2008. In the June 2010 Emergency Budget statement the new coalition Government announced that the Income Support (IS) entitlement conditions will change to include those lone parents whose youngest child has reached five. This change is expected to be implemented in early 2012.
Lone parents who are no longer eligible for IS are able to move to other benefits, as appropriate, including Jobseeker’s Allowance (JSA) and Employment and Support Allowance. The JSA regime has been amended to include flexibilities for parents, for example, in the hours of work they are required to seek. The Welfare Reform Bill will also require single parents with youngest children aged three to six to improve their employability. Evidence suggests that Lone Parents who are not in work tend to have different characteristics and personal circumstances to those in work13. For instance, lone parents who are not in work tend to have worse self‐reported health, lower income and greater financial related problems, lower qualifications, lower vehicle access and higher levels of social renting. A national survey undertaken by the DWP14 provides evidence of multiple types of need or disadvantage among lone parents on income support. Although respondents tended to view these issues as restricting the type or amount of work they could do, rather than preventing it altogether, at least in the longer term. In fact 78% of respondents reported wanting to work and 69% thought they would work in the next few years. 12
Annual Population Survey (2010) Families, Poverty, Work and Care (DWP, 2001) 14
Lone Parent Obligations: Supporting the Journey Into Work (DWP, 2011) 13
93 Nevertheless, a range of barriers continue to limit employment opportunities for lone parents, with qualitative studies showing that it is the availability and cost of childcare that is the largest single factor in a lone parent’s decision whether or not to work. Other identified factors include:  Financial issues – the problems of making the transition into work from benefits and concerns whether work will provide them with sufficient income to manage;  Paying for housing – with particular confusion over the links between in‐work benefits and Housing Benefit;
 Morale, self‐confidence and hardship – ‘low‐morale’ is four times more likely to be experienced by those in severe hardship than those not in hardship. A vicious circle is created as those with low self‐esteem and little confidence in what they have to offer are much less likely to find employment;  Employer attitudes – the feeling that employers lack sympathy for the family situation, lack flexibility or are actively prejudiced;  Mobility/Transport ‐ One of the key barriers to social inclusion (not just employment) for lone parents is access to reliable, affordable, convenient and child‐friendly transport. National research15 emphasises the fact that lone parents are not a homogenous group, but instead one which displays a wide range of characteristics and personal circumstances. This is particularly true in respect of older and younger lone parents, those who are divorced, separated, widowed or never married, and those who have never cohabited. These differences in the situation surrounding lone parenthood have a profound impact on the process of finding a job. For instance:  An older lone mother may be in a better position to get a job, having had some previous work experience, unlike a younger (especially teenage) lone mother, who may never have worked;  A younger mother may have greater need for child care facilities if she is to work as she is more likely to have younger children in need of either full daycare or after‐school care. Support from grandparents (who are likely to be of working age themselves) tends to be less readily available;  A single, never married or cohabiting lone mother may have less opportunity of child care from the child’s father, or, for that matter, his parents;  The younger mother may also have a greater chance of being presented to the authority as homeless and thus of having to move away from her family in order to find accommodation quickly. However, national research with lone parents highlights the importance of generating part‐time vacancies to moving many lone parents into work – particularly school‐hours opportunities16. 15
16
Much the Wiser? Twenty Years of Evidence on Non‐employed Lone Parents, Tina Haux (University of Essex) Lone Parent Obligations: work, childcare and the Jobseeker’s Allowance regime (DWP, 2011) 94 Ex Offenders National research indicates that finding sustainable employment reduces the likelihood of an individual reoffending by between one‐third and a half17. There is an increasing recognition that it is not employment alone, but the interaction between employment and events such as family formation that both encourage and enable ex‐offenders to desist from crime18. In 2005, the Government published Reducing Reoffending through Skills and Employment, which sought to place employment as key to leading a crime‐free life. However, an estimated 75% of prisoners are released from custody without having secured work, with the result that offenders rely heavily on social ties in order to find employment. This combined with a range of barriers to employment means that unemployment among ex‐offenders remains very high, with ex‐offenders also more likely to be among the long‐term unemployed. Whilst having been in prison increases the likelihood of unemployment, the problem of unemployment amongst people with a criminal record is neither restricted to ex‐prisoners nor is caused, solely, by incarceration. Anyone with unspent convictions faces much greater difficulties in gaining a new job, whilst employees who are convicted of an offence or whose previous (hidden) record is revealed may face dismissal19. For about half of vacancies, employers are likely to reject most people with a criminal record solely due to their record, despite the fact that approximately one‐third of all males aged under‐30 in the UK possess a criminal record. Those with more serious convictions (and even minor sex offences) will be rejected for about 90% of vacancies due to their conviction. Prison, the seriousness of the offences and the length of record exacerbates unemployment difficulties20. The main causes of such high unemployment among ex‐offenders include:  Poor employment characteristics (e.g. literacy, qualifications, employment record);  Other characteristics which can reduce employment performance (e.g. drug dependency, homelessness);  Being drawn disproportionately from groups with higher rates of unemployment (e.g. ethnic minorities, men);  Employer discrimination; and  Problems over revealing a criminal record (e.g. lack of confidence). 17
Going Straight: Reducing Re‐Offending in Local Communities, Local Government Association, 2005 Ex‐Offenders, Social Ties and The Routes into Employment, Dr James Rhodes, Internet Journal of Criminology, 2008 19
Barriers to Employment for Offenders and Ex‐Offenders, Hilary Metcalf, Tracy Anderson and Heather Rolfe, DWP 2001 20
Employer Consultation Survey: Employers’ Attitudes to the Employment of Ex‐Offenders, IMPACT (2006) 18
95 Health, Disability and Mental Health At a national level21 the latest thinking is that some groups of people who are not in work due to ill health do not necessarily need to make a full recovery to be able to return to work. However, a shift in the thinking of those currently claiming Incapacity Benefit, GPs and others may be required to achieve this. Employer engagement is also important in any attempt to assist individuals with health problems to return to work. Moreover, it is important to keep long‐term IB claimants close to the labour market, through volunteering or training to update their skills, for example, so they are as close to the labour market as possible should their health condition improve. A recent report for the London Borough’s of Kensington & Chelsea, Camden, Islington and Westminster22 found that the range of support required for those on Incapacity Benefits to return to work depended on a number of factors such as the health condition, the severity of that condition and the length of time out of work. However, respondents to a survey in the boroughs felt they faced multiple difficulties in getting back into work including age, time out of the labour market, employers expectations and perceptions, lack of confidence, fear of drug/alcohol relapse, and housing and finance issues. The type of support that respondents felt they needed also varied by type, severity and duration of condition. However, whilst direct employment support (such as CV development, job search and interview skills) and help with filling out forms were frequently mentioned, on balance other (non‐employment) support needs outweighed them. These included support for day‐to‐day activities, support with financial management, coaching and therapy, housing, education and training. Support was also needed for making the transition into work and once in work. Respondents on IB wanted to get this support primarily from GPs, Citizen’s Advice Bureaus (CABs), community centres and charities. The Disability Discrimination Act (DDA) 1995 made it unlawful for disabled people to be discriminated against by employers. This includes people in the application process as well as employees. The DDA says that ‘reasonable adjustments' must be made to ensure that disabled people are treated fairly. For example, this could include inviting a supporter to accompany someone with a learning disability to an interview, or limiting the number of tasks someone with a learning disability takes on in their first few months in post. The Disability Discrimination Act (DDA) 2005 places a duty on public sector bodies to implement disability equality in their role as employers. The Disability Equality Duty (DED) requires employers to consider their employment policies and the duty to make adjustments in a more proactive way – so that discrimination may be eliminated prior to its arising. The Government’s welfare reform agenda emphasises the importance of getting more people with disabilities into employment. However, despite this and equality legislation, significant barriers continue to make access to employment difficult for individuals with a physical disability, learning disability or common or severe mental health condition. 21
Working for a Healthier Tomorrow, Dame Carol Black (2008) Customer Insight into Employment Support for Long‐term Incapacity Benefit Claimants, Centre for Economic & Social Inclusion (2011) 22
96 Nationally it has been estimated that only around 10% people with a learning disability are in employment, compared to an estimated 50% of disabled people of working age23. Where people with a Learning Disability do work, it is often for low pay and for part‐time hours. Research shows that 65% of people with a learning disability want to work24, but that a range of barriers make it difficult to access employment. These barriers include: 




Lack of appropriate training: Many people with a learning disability do not have access to quality further education and training. Only 1 in 3 adults with a learning disability take part in any education or training. Lack of appropriate support: People with a learning disability often need support to develop key skills for work and to find and get a job. They may need support in the workplace. Government disability employment programmes do not meet the needs of people with a learning disability. The welfare system: There are certain structural barriers within the benefits system which can make it very difficult for people with a learning disability to achieve their aspiration to work. For example, the amount of money that can be earned by recipients of welfare benefits without their benefits being affected is extremely low. This can mean that people are not necessarily any better off if they work. The consequence is that people with a learning disability can remain trapped in poverty, reliant on welfare benefits and unable to contribute to society. Employers attitudes: Many employers are reluctant to take on someone with a learning disability. This might be because they do not know enough about the benefits of employing people with a learning disability, or they do not know how to get the right support. Stigma and discrimination about people with a learning disability is still widespread. Discrimination: People with a learning disability often receive little or no pay for work they do on an on‐going basis. It is described as ‘work experience', and does not lead to real pay or a real job. People who experience severe and enduring mental health problems have one of the lowest employment rates. Only one user in five of specialist mental health services either has paid work or is in full‐time education25. At the same time, people with more common mental health problems such as depression or anxiety also face difficulties in gaining employment and if in work are at risk of losing their job. For instance, it is estimated that at any one time one worker in six will be experiencing depression, anxiety or problems relating to stress26 . 23
Valuing People, Department of Health (2001) Institute for Health Research, Lancaster University (2005) 25
Health Care Commission, 2008 26
Psychiatric Morbidity among Adults Living in Private Households, Singleton, Bumpstead, O’Brien et al (2001) 24
97 Among the barriers identified for people with mental health issues are: 


Stigma and discrimination in the workplace: 52% of UK organisations say they have never knowingly recruited anyone with a history of mental ill health27. At the same time it is recognised that those in work often feel isolated and ostracized by colleagues who do not know how to support them28. Low expectations and lack of resources: For instance only 3% of companies have a comprehensive Occupational Health Service29, while many GPs have historically been too quick to sign individuals off work. Many health care workers focus on continuation of treatment rather than on recovery and a return to independent life, with the Health Care Commission noting that only half of mental health service users in contact with specialist mental health services report having received any help with employment. Financial disincentives: Incapacity benefits were originally introduced to provide additional support for those unable to work due to long‐term ill health. But the system created financial disincentives for anyone wishing to return to work. Many feared that they would lose their entitlement to benefits before they could cope with an ordinary job. The Welfare Reform Act and forthcoming changes to housing and council tax benefits aim to remove these disincentives, but the fear still remains for people with recurring ill health that a return to work will leave them worse off. Health & Safety in the Workplace Officers from the Local Authority Food and Safety Team investigate notifications of major injury incidents and fatalities affecting workers in the work place (around 220 health and safety inspections per year from approximately 3,000 premises). The prevention of ill health through the investigation of accidents and dangerous occurrences aims to reduce the likelihood of further injury or ill health. According to the Health and Safety Executive in 2010/11, 1.2. million people suffered from work related illness and 26.4 million working days were lost due to work related illness. In 2009/10 the cost of work place injuries and ill health cost society an estimated £14 billion. There is a further responsibility for the prevention of ill health through the inspection of high risk or poor performing businesses with regard to health and safety. Local Authority officers visit high risk workplaces to provide guidance and advice on effectively managing health and safety in the workplace and therefore reducing the likelihood of accidents or occupational diseases to the workforce (this includes stress, back and limb injury). Current initiatives being undertaken relate to health and safety in care homes relating to slips, trips and falls and scalding, infection control at beauty shows (piercing) and gas safety at take away food businesses. Approximately 220 health and safety inspections are carried out each year by the Local Authority. 27
Chartered Institute of Personnel Development (2007) Shunned: Discrimination Against People with Mental Illness, Thornicroft (Oxford University Press, 2007) 29
Mental Health and Work, Royal College of Psychiatrists (2008) 28
98 Employer Based Health Promotion Dame Black’s review30 of the health of Britain’s working age population identified the importance of healthy workplaces designed to protect and promote good health and the central role that such workplaces play in preventing illness arising in the first place. This review sought to establish the foundations for a broad consensus around a new vision for health and work in Britain. At the heart of this vision are three principal objectives:  prevention of illness and promotion of health and well‐being;  early intervention for those who develop a health condition; and  an improvement in the health of those out of work – so that everyone with the potential to work has the support they need to do so. The Government’s response31 to this review identified a range of key indicators to measure progress on these objectives and provide national evidence on the links between employment and health and wellbeing at a national level. Furthermore, an SMBC review of Public Health in 2011 acknowledged that the regulation of health and safety, the provision of advice, and occupational health schemes are effective in reducing injuries and work‐related ill‐health. This in turn reduces sickness absence; compensation claims and improves the general health of employees. Survey evidence shows that the majority of employers agree that there is a link between work and the health and well‐being of their employees and that they have a responsibility to encourage employees to be physically and mentally healthy. Employers were more cautious regarding return on investment in health and well‐being, with just over half (56%) agreeing that the financial benefits of spending money on employee health and well‐being outweigh the costs. The same employer survey shows some evidence of an unwillingness to intervene: 51% of employers agreed that in general, their employees did not want them to intervene in terms of their physical and mental health. Employers were also asked to identify which benefits their organisation had provided in the last 12 months, irrespective of whether these were made available to some of, or the entire workforce. The results showed that over half of surveyed UK employers provide health and safety training (74%), 20 or more days annual holiday (72%) and work area assessments and adjustments (64%), but that less than a quarter provided a range of other forms of support, including measures to encourage activity such as running, cycling and walking (20%), health advice/ events to raise awareness about healthy lifestyles (18%), access to counselling or other employee assistance programme (16%), health screening or health checks (13%) and occupational health services (13%).
30
Working for a Healthier Tomorrow: Dame Carol Black’s Review of the Health of Britain’s Working Age Population, March 2008 31
Improving Health and Work: Changing Lives, November 2008 99 For almost all initiatives and benefits, large employers were most likely to report provision, followed by medium employers with small employers least likely to be providing health and well‐being benefits and initiatives. Employment sector was also associated with the provision of initiatives and benefits. Public sector employees were more likely to mention almost all initiatives and benefits than private sector employees. However, this is linked to employer size: public sector workers were more likely than private sector workers to work in organisations with 250+ employees. Organisations with a recognised trade union were also more likely to offer health and well‐being benefits but these findings are linked: public sector organisations tended to be larger than private sector organisations and trade union presence is a feature of large / public sector organisations. The notable exception to this was subsidised private medical insurance which was more likely to be reported in the private sector than the public sector. The survey also examines employer attitudes to stress, which is increasingly being cited as a cause of ill‐health in the workplace by employers and employees. Overall, 17% of organisations surveyed provided stress management support or advice but this varied by organisational characteristics. Large employers were four time more likely to provide stress management (64%) than those in small organisations (15%). Public sector organisations and those with a trade union presence were also more likely to provide stress management support and advice.
Total Yes 17% No 83% Source: GfK NOP Employer Provision of Stress Management or Support or Advice Organisation Size Organisation Type Trade Union Small Medium Large Public Private Yes No 15% 38% 64% 32% 14% 26% 16% 85% 62% 36% 68% 86% 74% 84% Keeping people with health conditions in work wherever possible is a key policy objective because of the links between working and long‐term health outcomes. To further understand the extent to 100 which employers are taking steps to retain employees with health conditions in work, the survey asked employers were asked about the actions they had taken in the previous 12 months to keep employees with health problems in work or facilitate their return to work. A third of employers (33%) reported having taken at least one action and these were most likely to be large organisations (96% of large organisations compared with 79% of medium organisations and 30% of small organisations). The measures most commonly used by employers to keep employees with health problems in work or help them return to work were: allowing employees to work reduced or different hours (29%) and meetings to discuss extra help employees might need to return or stay in work (28%). Flexible working (including flexi‐time, working from home, job sharing, and the ability to change hours, work condensed hours or change working patterns) allows people with family or other caring commitments to balance work and other responsibilities and is generally viewed as a positive working practice. Research with employers found that six in ten (61%) reported that their organisation offered flexible working practices to their staff and, as in the employee research, this was more likely to be the case amongst large organisations. The Government’s response to the Black Review stressed the importance of monitoring the health status of the working‐age population because this provides an important insight into how people feel about their own health. The General Lifestyle Survey32 shows that those in work report better health than those who are unemployed or economically inactive. Of those in work, those in managerial/professional occupations report better general health than workers in lower supervisory or technical occupations or semi‐routine occupations. 32
General Lifestyle Survey (GLF), ONS 101 There are no significant differences by gender and as, would be expected, as age increases respondents are increasingly likely to report ‘fair’ and ‘bad’ health. A large proportion (64%) of the economically inactive are aged 45‐64, a group who are more likely to report poorer general health. Priorities for Commissioning •
Multi‐stranded employment policies to promote access to work and reduce long term unemployment; •
Promote access to work and remove barriers for disadvantaged groups; •
Promote health at work programmes, particularly in the public sector and SMEs. 102 EnsureaHealthyStandardofLivingFor
All
Key Findings •
Solihull has comparatively low levels of households in poverty: –
20% on low income/Council Tax Benefit (22% nationally) –
15% (7000) children living in poverty (21% nationally) •
Levels of poverty are considerably higher in North Solihull Regeneration area (third of households living in relative poverty); •
Inflation and recession has increased poverty levels. Poverty Solihull’s Action Against Poverty Needs Assessment (2011) provides a comprehensive analysis of the extent of poverty in the borough, as well as its causes, drivers and impacts. The most commonly used quantitative definition describes ‘relative poverty’ as ‘living in a household where the income is 60% or less of the median, or middle, income before housing costs’. For households in relative poverty material deprivation becomes a more apparent problem as they struggle to meet basic needs like food, heating, transport, clothing and costs associated with education. However, it is recognised that poverty is not just material, it can negatively effect an individuals life chances and become entrenched and inter‐generational. As a result neighbourhoods with high levels of relative poverty are subject to a range of inequalities, including: 





Poor health outcomes/lifestyle choices; Higher crime and ASB rates; Higher rates of teenage conceptions and lone parents; Below average education attainment; Higher levels of debt and demand for debt/money advice services and; Low self esteem and educational aspirations among children and young people. National research shows that for many measures on poverty (both households and children) the West Midlands is the most disadvantaged region in the UK. Evidence shows that, in contrast to the country as a whole, poverty increased in the West Midlands prior to the Recession. 103 Local evidence suggests that Solihull is subject to lower levels of poverty than both national and regional benchmarks: 

19.7% of households in Solihull are on a low income and receive Council Tax Benefit, 22% of households in the UK are classified as income poor; 7,015 children in Solihull live in poverty equating to a rate of 15.2%, compared to 20.9% nationally and 23.3% in the West Midlands. Modelled data from the ONS shows the proportion of households in Solihull living in relative poverty (60% below median income) by Middle Layer Super Output Area (MSOA). Around a third of households living in the six North Solihull Regeneration MSOA are estimated to be living in relative poverty, with the next highest neighbourhood in the borough, Hobs Moat (Lyndon ward) having a rate of approximately 22%. Analysis of benefit recipients in the Borough provides insight into the groups most vulnerable to poverty. Around 17,500 or 20% of households in Solihull are dependent on benefits, the largest group being couples on a pension with over 4,200 claimant households (4.8% of all households), followed by single people of working age with no children (3.9%) and single pensioner households (3.1%). 104 Benefit Dependent Households in Solihull
Source: DWP
42% of all benefit claimant households are from the north Solihull regeneration wards (Chelmsley Wood, Kingshurst & Fordbridge, Smith’s Wood), ranging from 54% of single households with children to 31% of pensioner couples. On average 44% of households in the north Solihull regeneration wards are dependent on benefits compared with 14% in the rest of the Borough. Benefit Claimant Households in Solihull
North Solihull Regeneration Wards
Source: DWP
Within Solihull there are also clear geographical variations in the extent of households and children in poverty, broadly corresponding with patterns of overall deprivation (as measured by the Index of Multiple Deprivation) and worklessness. 105 
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


60% of Solihull children in relative poverty (as measured by NI 116) live in North Solihull; In North Solihull 36% of all children live in relative poverty compared to 15% across the Borough as a whole; In some LSOA neighbourhoods in North Solihull over a half of children are in relative poverty; There are pockets in the rest of the borough (Lyndon, Elmdon, Shirley and Castle Bromwich) where more than one in five children are in relative poverty; Across most of the Borough the highest proportion of children in poverty are aged 5 to 10 years, however, in North Solihull the highest proportion is in the 0 to 4 years age bracket. Employment status is the key determinant of poverty, with the unemployed and those in low paid work vulnerable. Paid work is not, on its own, a guarantee of being free of poverty. In 2008/09, 61% of income‐poor children in the country as a whole were in households where one or more parents were in work. Low wages, part‐time work and not having two adults in work in a household all increase the risk of poverty. 

Families who rely solely on a minimum wage and in work benefits fall well below the poverty line; Nationally, children in workless households have a 58% chance of living in poverty, roughly one in six children growing up in a household where no‐one works. The Action Against Poverty Needs Assessment recognises that there are additional factors which can contribute to individuals and families falling into and becoming entrenched in poverty and consultation identified a range of factors that make breaking the cycle of poverty difficult, including: 

The difficulties of servicing high cost borrowing; The increased risks of social isolation and the barriers to participation for children (activities, school trips etc); 106 
Childcare, particularly provision for non‐standard hours. The risks of individuals and families falling into poverty have been exacerbated by rising worklessness as a result of the recession (with certain groups such as the low skilled and young people finding it more difficult to re‐enter the labour market). This has been notable through an increase in demand for money and debt advice services in the borough. For instance, debt enquiries to the three Citizens Advice Bureaux (CAB) in Solihull increased by 33% between 2008/09 and 2010/11, while benefit enquiries increased by 24%. Alongside rising worklessness, inflation has been a major contributor to rising poverty levels, particularly in relation to priority expenditure. National statistics have reported that in the past four years, 2008 to 2011, food and domestic fuel have risen much faster than inflation generally, meaning that the cost of these essentials has for many families in poverty been rising faster than their incomes. In the past 3 years: 



The official inflation rate has shown prices rising by a total of 11%; Food has gone up by 19% nearly twice as much, and domestic fuel by 31%, nearly three times the official inflation rate; The number of households in fuel poverty has increased significantly from 2003 to 2008 and are expected to continue to increase due to rising fuel prices and falling incomes in real terms; In March 2010 there was a reported increase of Solihull’s households in ‘fuel poverty’ with an estimated 13,469 or 15% of Solihull’s households. A further poverty risk identified by the Action Against Poverty Needs Assessment is the current changes to the welfare benefits system. The effective functioning of the welfare and benefits system is critical to alleviating poverty and this Assessment considers future changes in the benefits system in detail, with entitlement to and take‐up of benefits.
Payments of Benefits and Tax Credits that act as a safety net are often too low to protect households from poverty. For the majority of households on benefits their income level remains significantly below the poverty line. As a result, the way in which the benefits system functions is, alongside employment, one of the key determinants of poverty. The Government is undertaking the most radical restructure of the welfare benefits system in 60 years through the Welfare Reform Bill (Royal Assent, April 2011). The key aim of the Government’s reform programme is to create a system where people are better off in work than they would be on benefits. However, it is clear that these reforms will create a number of challenges for both residents and the Partnership. Among the main changes proposed are: 

The Bill proposes to limit the amount of benefit an out of work household can receive, which is expected to disproportionately affect larger families, those with 4 or more children; Universal Credits will replace Housing Benefit. Council Tax Benefit (CTB) will be replaced by a new system known as Council Tax Support (CTS) – CTB will cease from 2013/14, CTS will be designed and administrated by each Local Authority with the Government contributing 10% less funding than currently with CTB; 107 
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Responsibility for delivering Crisis Loans and Community Care Grants will be transferred from the DWP to Local Authorities. The new locally‐based assistance scheme will give Local Authorities maximum flexibility to deliver services according to local needs; The role of supporting residents before and during the change to Universal Credit as well as into the future will need to be met by the Council and Partners. There may also be a requirement for the Local Authority to deal with face to face enquiries for Universal Credit; Universal Credits will include an amount for everyday living expenses, housing costs and dependent children. The focus on supporting people into work is supported by paying UC on a reducing scale as earnings increase; A range of back to work programmes have already started to support and actively encourage working age claimants into work. This approach is underpinned by setting out claimants’ responsibilities in the form of a Claimant Commitment that spells out the expectations on which payment of benefit is based and the consequences of not meeting those commitments. The Bill gives little precise detail of the changes; much will be developed through consultation, statutory instruments and guidance. Further work will be undertaken to help understand the impact of the changes for the Council and residents and shall be included in this Assessment’s 2012 refresh. Segmentation The inverse care law (first suggested in 1971 by John Tudor Hart in The Lancet) attests that those with the greatest need of health care are least likely to use it (and less effectively when doing so). A substantial body of evidence has grown over the past four decades to support this view, perhaps culminating in the principle of proportionate universalism (Marmot, 2010) ‐ the scale and intensity of action should be proportionate to the level of disadvantage. Notably, health disadvantage within Solihull when compared with overall deprivation (Index of Multiple Deprivation 2010) reveals a very strong correlation between deprivation and adverse health outcomes (0.95). Later sections of this assessment will present findings from specific epidemiological data for key groups across Solihull. However, it is felt useful from the outset to consider what might be done to close the inherent gap of inequality by improving the health and well‐being chances of those in most need fastest. This requires an understanding of what motivates people and how we can use this insight to shape policy‐making and service delivery. Customer Insight enables decision‐makers to visualise and identify groups of customers (segments) who have common needs. Revealed ‘truths’ should then unlock opportunities and help generate ideas to redesign services in ways that might save money, target those in most need and hopefully improve customer satisfaction. This is also important so that we might understand the changing customer base in terms of socio‐demographics (address need to future proof services) and expectations (demands for greater customer focus in providing personalised, user‐friendly and interactive services). Specific tactics include: Marketing services more effectively – help encourage take up of services or different channels by specific groups (includes those that are ‘hard to reach’) Right services available for the right people in the right place and at the right time (incorporates Operational Research – outside scope of this assessment) Communications offer services that people need and are eligible for in a way that they are likely to respond to Resources can be allocated down to neighbourhood/segment level 108 Change behaviours – targeted services which can change customer behaviours Services can be tailored for specific needs and delivered more effectively By looking at who is using a service, it can be induced who isn’t and by determining why can seek to reach non‐users (this includes identifying and giving support to vulnerable groups) Using the Healthy Foundations segmentation tool (developed by the DoH),of the five groups the Live For Today population segment is most redolent of priority intervention. This segment is found to come from more deprived areas, exhibit fairly poor health behaviours, be the most likely to drink and smoke heavily and have little concern for their future well‐being. Furthermore, the Live For Today lifestyle is found to be ‘chaotic’ and unstructured, claimed as a choice by some but for most seems to be a consequence of external circumstances or influences (only 21% have positive mental attitudes, 32% currently smoke, 21% are obese or very obese and only 31% consume at least recommended amount of fruit and veg). Using Customer Insight techniques there is a degree of influence that can be exerted on this group to help improve outcomes (introduced below relative to other segments): Change ‐ most resistant and most likely to defer Need clear advice delivered to understand need for change (prerequisite for subsequent approaches). Requires on‐
going monitoring, mentoring and evaluation (links to risk) Need to clarify risk levels and need for change before embarking on an intervention Require support to plan and structure lifestyle (may be signposted to as part of a co‐ordinated approach to multiple issues – once addressed need to change). Risk Explicit – risk is perceived only when physical harm is explicit Unhealthy Behaviours – less likely to believe health is at risk (from unhealthy lifestyles), fatalistic and short‐term outlook, explained as a response to stress/ negative emotions Health Locus (External) – less likely to Consider Cognitive Behavioural Therapy and other be in control and lack self reliance psychological approaches. Consider each issue on a stage‐
by‐stage approach (in a structured format which sets goals and celebrates successes) Hands‐on, practical, personalised approaches might Service Use – low which includes screening attendance (average levels sometimes work best away from a health setting. of satisfaction) Community Facilities – not motivated Value NHS brand highly and identify strongly with local to utilise area. Friends are a positive social influence – importance of peer testimonials Information/Advice – won’t ‘shop ‘Nudge’ information on short‐term/current risk need to be around’ proactive. Believe GP is the best source of health advice. In order that this assessment might provide some indication of where the segments (particularly the Live For Todays) are most likely to be found in Solihull, a geo‐demographic approach is required (combining data, segments and neighbourhoods). The Sport England Market Segmentation provides 19 segments with pen portraits and associated data tables that covers the adult population of England split down to postcode or output area level. Considering demographic factors (gender, age, and employment status), behaviour (healthy lifestyles and attitudes) and environmental factors 109 S
Englan
nd segmentss were crosss‐tabulated with the H
Healthy Foundations (deprivaation), the Sport segmentts (summaryy table below
w): Segmen
nt England Solihull S
Poortrait (%) (%) Health C
Conscious 23 25 Inn control of th
heir lives and
d their healthh, older averrage age, Realists (HCR) livve in the leasst deprived a
areas Balanced 18 20 Hiighest propo
ortion of people in full‐tim
me work, exeercise Compen
nsators reegularly and eat healthilyy (BC) Live For Todays 20 19 Coome from more deprived
d areas, littlee concern for their (LFT) fuuture well‐beeing Hedonisstic 20 16 M
Motivated by risk and enjo
oyment, younnger average age, Immortaals (HI) coome from lesss deprived a
areas Unconfident 19 20 O
Older averagee age, retired
d, hold negattive perceptions of a Fatalistss (UF) heealthy lifestyyle The following map illustrates a a probabilityy from the above meth
hod for the key Live Fo
or Today segmentt at output aarea level: The follo
owing chart highlights the t stark diffference between the North Solihul l Regeneration Zone (NSRZ) aand other parts of Solih
hull. There are pockets of deprivattion outside of the rege
eneration 110 wards (notably in Castle Bromwich and across the Urban West) but there is a remarkable uniformity and spread for the segments other than Live For Today (which is applicable borough‐wide for Unconfident Fatalists). This suggests that it might be difficult to adopt a geo‐demographic approach other than for the Live For Today segment and that health services will need to consider a variety of approaches in most areas. However, there might be an opportunity to approach proportionate universalism from an asset based approach7 for positive health outcomes, if the collective resources of the Health Confident Realists and Balanced Compensators are deployed effectively (these groups might account for 51% of households in the rest of North Solihull and the Urban West, and 58% in the Semi‐Rural South and East). LFT
100%
90%
80%
70%
1,140
986
1,059
UF
HI
BC
HCR
2,024
12,619
1,403
10,213
1,079
7,878
2,935
60%
50%
40%
30%
5,660
12,731
3,666
1,339
9,629
875
4,755
Other North
West
20%
10%
0%
NSRZ
4,844
3,499
386
Semi‐Rural
Closing the Gap of Inequality The Index of Multiple Deprivation (2010) provides a useful starting point for understanding
inequality in Solihull. The IMD combines a number of indicators, chosen to cover a range of
economic, social and housing issues, into a single deprivation score for individual
neighbourhoods called Super Output Areas (LSOAs) in England. There are 32,482 SOAs in
England and 133 in Solihull and the minimum population for a LSOA is 1000 and the
average is 1500. The Index of Multiple Deprivation therefore allows each neighbourhood
(LSOA) to be ranked relative to one another according to their level of deprivation. The IMD
consists of the following seven components:
Domain
Weighting
Income Deprivation
22.5%
Employment Deprivation
22.5%
Health Deprivation and Disability
13.5%
Education, Skills and Training Deprivation
13.5%
Barriers to Housing and Services
9.3%
Crime and Disorder
9.3%
Living Environment
9.3%
111 The overall (aggregate) IMD shows that there are 22 LSOAs in Solihull the most deprived
20% of neighbourhoods in England of which 15 are in the bottom 10% and 2 in the bottom
5%. Compared with 2007 there are more Solihull LSOAs in the bottom 10% nationally (15 vs
10) and there are now two LSOAs in the bottom 5% compared to none in 2007.
All of the LSOAs in the bottom 10% in 2010 are in the North Solihull regeneration wards
(Chelmsley Wood, Kingshurst & Fordbridge and Smith’s Wood), the most deprived being
Cole Valley (CW) and Chelmsley Wood Town Centre which both have a percentile rank of
4.8. Hobs Moat North (17.6 percentile, Lyndon ward) is the most deprived LSOA outside of
the regeneration area, with Olton South, Ulverley East (Lyndon), Green Hill (Shirley East),
The Cities (Bickenhill) and Parkfields (Castle Bromwich) also in the most deprived 30% in
the country.
At a Local Authority level the population weighted IMD rank shows that as a Borough Solihull
is ranked 212th out of 326 LAs in England (64th percentile). By way of comparison, the
percentile rank for Birmingham is 3.7 (bottom 4%), Coventry is on the 16th and Warwick on
the 80th.
Comparing each LSOA’s IMD rank in 2007 with rank in 2010 shows that those LSOAs which
have recorded a fall in national rank and therefore a relative worsening in overall deprivation
are largely clustered in two areas:


The North Solihull regeneration area, especially in LSOAs surrounding Chelmsley
Wood town centre and in Arran Way (Smith’s Wood);
The urban west of the borough bordering Birmingham (including the wards of
Lyndon, Olton, Shirley East, Shirley South and Shirley West) parts of which have
been identified as pockets of relative disadvantage in terms of employment.
112 Health Context of Inequality The following chart reveals the slope index of inequality for life expectancy by deprivation deciles from 2001‐05 to 2006‐10 (note that UT is the median value for the 150 Upper Tier authorities). 12
Male (SOL)
Female (SOL)
Male (UT)
Female (UT)
2003‐07
2004‐08
2005‐09
10
8
6
4
2
0
2001‐05
2002‐06
2006‐10
The main observation is the apparent convergence of the Male and Female index over the time period above (Male has increased by 9.1% from 9.9 to 10.8 compared with Female – 25.6% from 8.2 to 10.3). There is also a substantial gap with the Upper Tier median at 8.9 for Males and 5.9 for Females (2006‐10) – this is far more pronounced for Females in Solihull being 74.6% higher compared with Males (21.3%). The following map reveals that the Female slope index of inequality for Solihull is more than two standard deviations above the Upper Tier mean (note this is purely an illustrative measure to highlight the pattern that appears to be common in post‐industrial Northern England): 113 It is known nationally [Marmot report – Fairr Society, He
ealthy Lives, 2010] that tthe established social gradientt for health iis even steep
per for disabbility free life
e expectancyy than actuall life expecta
ancy (the average difference b
between rich
hest and pooorest neighb
bourhoods is seventeen yyears compa
ared with seven fo
or life expeectancy). The London Public Health Observattory providees a set of Marmot indicato
ors for Local Authoritiess in England . The chart below sho
ows key ind icators of th
he social i
th
hat correspoond, as closely as is determinants of heealth, health outcomes and social inequality currently possible, to the indiccators propoosed in Fair Society, Healthy H
Livess. Results for each or below are for Solihull ‐ on the chaart, the value
e for this loccal authority is shown ass a circle, indicato
England, show
wn as a bar.
against tthe range of results for E
114 Further inequalities can be seen in the table below that w
will need to be improvedd across the gradient to addreess health ineequalities: Environm
mental Cond
ditions (water/aair quality, ggreen space/b
bio‐diversity,, flood risk, litteer and landffill) Active TTravel Access tto good quallity green sp
pace Pollution (including carcinoggenic chemiccals) Noise Po
ollution Crime an
nd Anti‐Sociial Behavio
our (ASB) In the most ddeprived area
as 45% of the
e populationn experience 2 or more unfavo
m
urable condiitions compa
ared with lesss than 5% in the least depriveed areas (Deffra) The lower the
T
e social grad
de of a person the less like
kely they are to travel (National Tra
(
avel Survey). There is also a link withh a lack of loccal food shops. s
Those in lowe
T
est social gra
ade are likelyy to visit greeen spaces lesss frequently (li
f
ikely due to low availabiliity and bad qquality in dep
prived areas – Defra
a
a with the En
nergy Saving Trust) – greeen space heelps to decrease bloo
d
od pressure and choleste
erol, improvee mental hea
alth and face problem
the ability to t
ms, encourag
ges integratiion, space fo
or physical activ
p
vity, improvees air quality and reducess urban heatt island effects e
Poorer comm
P
munities on a
average expe
erience higheer concentrattions of pollution and
p
d particulatess with a subssequently higgher prevaleence of cardio‐respir
c
ratory diseases. as of high deensity housin
Worse in are
W
ng, rented acccommodatio
on, areas of deprivatio
o
n and areas which are hiighly urbanissed. This can
n in
ncrease stresss and hyperrtension in adults and redduce educatiional outcomes in o
children – bo
oth have advverse effects on mental h
health. There is a cor
T
rrelation bettween crime deprivation and social ho
ousing (from 2004 IM
(f
MD and 2001
1 Census) bu
ut crime hotsspots are also
o likely to found in st
t
trategic loca
ations. In terms of ASB raates in Solihu
ull are considerably c
higher in thee Regeneratiion wards (ggreatest prop
portion and concentr
a
ration of sociial housing) than the restt of the boro
ough. It iss notable thaat environmeental and soccial managem
ement is invoked into statute for so
s
ocial housing
g tenants from the 1998 CCrime and Disorder Act (CDA). A
115 Food (greater access to unhealthy food may disproportionately affect those in more deprived areas) Mix of shops in deprived areas is weighted towards fast food and other unhealthy food options ‐ low income groups are more likely to consume fat spreads, non‐diet drinks, meat dishes, pizzas, processed meats, whole milk and table sugar than higher income groups (to some extent this is driven by choice but more expensive ‘healthier’ brands have demonstrably less salt, sugar and saturated fat content). This affects levels of obesity where all of the growth in the past decade has been outside of the professional social grade (Health Survey for England, National Obesity Observatory) Housing (targeting home Increased housing density potentially leads to more people being improvements at low‐
exposed to weather extremes and flooding and cold housing is the income households main explanation for excess winter deaths – third of the poorest improves physical and quintile of houses in fuel poverty compared with less than 1% in emotional well‐being) richest fifth (also affects people living with asthma and other breathing difficulties – English House Condition Survey, DCLG). Children in bad housing are also more likely to have mental health problems, slow physical growth and delayed cognitive development. Neighbourhoods (integrate Clustering of housing into relatively poor or relatively rich areas has increased over the past few decades – those features of a local area the planning, transport, housing, environmental and that encourage health (good schools, health services, employment opportunities and good housing) also tend to increase house prices. health services to address social determinants of At the opposite end there is a ‘residualisation’ effect of social housing health) tenants with higher rates of unemployment, ill health and disability ‐ this feature of environmental association with health is perhaps more applicable to Solihull than the quality of housing (Decent Homes standards are good). The following matrix (derived from the Department of Health) identifies the interrelationship between some key public protection services (rows) and significant public health outcomes (columns): Enforcement of underage sales Proof of Age schemes Door step sellers/cowboy builders/advice Environmental Crime Private Sector Housing regulation Health & Safety Inspections/Initiatives Notifiable Accident Investigations Cancer Coronary Heart Disease Mental Health Accidents
Life expectancy/Poverty Infectious Disease Control 






Stress 
Stress 





Stress Stress 




Stress 






116 Taking doorstep crime for instance, research (Thornton et al 2006) has found that 40% of victims reported that the incident had a significant impact on the quality of their life, 10% suffered with moderate to severe anxiety 3 months later and 23.3% suffered with probable depression 3 months later. Also, the effect of burglary on older people in sheltered accommodation is considerable, as 2 years after burglary, they were 2.4 times more likely to have died or be in residential care than non‐
burgled neighbours (Donaldson 2003). Local evidence that supports the importance of taking a wider view of public health includes domestic noise enforcement activity, which generates upwards of 1000 complaints a year. Whilst anti‐social behaviour and/or substance misuse is often an element in the cause of these complaints, poor quality, high density housing with insufficient noise insulation between units contributes to the problem; most complaints come from the regeneration wards in North Solihull. As mentioned earlier, this is important because noise is known to cause stress and anxiety with measurable effects on physical and mental health (includes sleep disturbance, cardiovascular effects and damage to work or school performance – World Health Organisation 2012). Furthermore, there is a small but significant number of complaints where there is no external noise source. The complainants may be suffering from the physical effects of hearing damage or disease (which can lead to noise in itself as sufferers turn the volume up on TV’s), tinnitus (which may be exacerbated by prescriptions for other conditions) and other similar conditions. Environmental health officers in the authority would like to enhance relationships with health professionals who come across the consequences of noise and/or people who are complaining of noise when it is actually a symptom of disease or other ill health. In summary improved mental health and wellbeing is associated with a range of better outcomes for people of all ages and backgrounds. These include improved physical health and life expectancy, better educational achievement, increased skills, reduced health risk behaviours such as smoking and alcohol misuse, reduced risk of mental health problems and suicide, improved employment rates and productivity, reduced anti‐social behaviour and criminality, and higher levels of social interaction and participation. Social inequality of all kinds contributes to mental ill health, and, in turn, mental ill health can result in further inequality resulting in worse outcomes in employment and housing for people with mental health problems. The primary purpose of the Joint Strategic Needs Assessment (JSNA) is to provide a comprehensive local analysis of current, unmet and future needs to help Public Health (Local Authority) and GP Consortia to set the direction of the Joint Health and Well‐being Strategy (JHWS), and subsequently decide on joined‐up priorities for effective and efficient commissioning. It is expected that these priorities will seek to provide opportunities to move public health ‘upstream’ into a more preventive setting. This implies that there is a need to look at future needs from a less deficit oriented view than the current trajectory might suggest, working backwards to highlight the radical changes that need to take place. It is therefore desirable that the JSNA should simultaneously provide the ‘bigger picture’, in summary a simple agreed picture of need, and sufficient detail of all areas that might make a major contribution in promoting health and well‐being. This breadth is incorporated within this assessment and considers; employment, energy efficiency, early years development, education, lifelong learning, active travel, quality of the local environment, social networks, healthy lifestyles, occupational health, personal safety and housing. This approach augments the epidemiological insight that has been a feature of previous assessments. 117 hlgren and Whitehead W
ra
ainbow moddel of the main determinants of heaalth is a widely cited The Dah
framewo
ork for undeerstanding the social causses of the he
ealth gradien
nt: Integrating the determinants sho
own above w
within the sixx key policy o
objectives off the Marmo
ot Review nalysis to sit alongside poossible interrventions (used within this asssessment) enables moree detailed an
that migght be able to resolve some s
of the seemingly intractable problems p
parrticularly inh
herent in more deeprived areaas. The follo
owing chart highlights the life expectancy yearss gained if the t Most Deprived
d Quintile (M
MDQ) of Sollihull had thhe same morrtality rate as a the Engla nd average for each cause off death. Thiis is covered
d in more deetail in the section on prreventing ill health, thou
ugh note that thee high rankiing of Coronary Heart Disease and
d Lung Canccer suggestss the imporrtance of reducingg the prevaleence of obesity and smokking in Solihu
ull’s more de
eprived comm
munities. Life Expectancy Years Gained
1.2
1.0
0.8
Maale
Fe male
0.6
0.4
0.2
0.0
118 Housing Good housing is essential for health and individual wellbeing. The direct links between poor
housing and health is discussed in the following section.
At a Borough level, a broad range of housing of different types and sizes, of different values
and tenures are required to create and maintain mixed and balanced communities.
Solihull has a high level of housing need and there are a number of demand pressures
contributing to a growing difficulty in meeting the need for housing within the Borough. More
housing is needed because the number of households in the Borough is increasing:
population is projected to increase by around 20,000 between 2011 and 2028, more people
are staying single longer, more couples/families are separating and people are living longer
and continuing to live in their own home, often alone. The number of households is projected
to increase by 14,000 over the period 2006 to 2028. It is expected that by 2028 around one
third of all households will be single people including those over pensionable age, people
with disabilities and households splitting.
The number of people with disabilities will continue to increase and will drive the need for
specialist and supported housing to meet a range of needs. This will usually be affordable
housing, particularly for rent, but some market provision will also be required.
1. Homelessness
Poor housing and particularly homelessness negatively impacts on health and wellbeing,
creates pressures on social and health care services and has adverse effect on the
educational and economic prospects of people and communities. People who are homeless
have 40–50 times higher rates of mental health problems than the general population and
are also 40 times less likely to be registered with a GP.
Solihull’s rate of homelessness at 3.7 per 1,000 households is slightly lower than for the
region as a whole (3.8) but higher than the rate for England (2.0). During 2010/11 there were
311 homelessness acceptances (eligible, unintentionally homeless and in priority need) in
Solihull, representing an increase of 21.4% on 2009/10. Homelessness increases are also
being seen at regional and national levels.
In Solihull the main causes of homelessness are,



Domestic violence
Termination of a private sector tenancy
Parents, relatives and friends no longer being able or willing to accommodate
The Council works on a multi-agency basis to maximise the prevention of homelessness and
maximise housing options for households in need.
In addition to existing homelessness pressures, two specific concerns for 2012 are,

A concern that national Housing Benefit changes, which started to be implemented from April
2011, will increasingly make it harder for low income households to access the private rented
sector. This is compounded by strong market demand for privately rented accommodation
119 
Housing repossessions. Although these have not currently placed significant extra demand
on homelessness services, there is a concern that repossessions may increase in 2012 and
future years.
One aspect of homelessness is rough sleeping. The number of rough sleepers in Solihull is
relatively small (estimated at 5 in November 2011) but they are a vulnerable group and
therefore a co-ordinated multi-agency approach is required to ensure that a rough sleeper is
able to access appropriate services.
In relation to health, it is well documented that people who are sleeping, or have slept, rough
and/or are living in hostels, have significantly higher levels of premature mortality and mental
and physical ill health than the general population. Several sources have estimated the
average age of death of a rough sleeper to be between 40 and 44 years of age. Recent
DOH research [Healthcare for Single Homeless People, March 2010] has shown that this
client group consume around 4 times more acute hospital services than the general
population, costing at least £85m in total per year.
The Council works with partner organisations to co-ordinate an approach to the provision of
services to rough sleepers based on the services that are available in Solihull. This coordinated approach will be developed further in 2012, particularly with regard to rough
sleepers and access to health services.
2. Affordability
Affordable housing need is exceptionally high as Solihull has one of the most severe
affordability problems in the West Midlands Region. The shortage of affordable housing is
particularly acute in parts of the mature suburbs and the rural area. A Strategic Housing
Market Assessment which was completed in 2009 estimated that 70% of newly forming
households could not afford to buy or rent at market prices.
120 According to the DCLG from 2008 to 2010 the ratio of median house price to median
earnings in Solihull increased by 13% (from 6.91 to 7.81), while the ratio of lower quartile
house prices to lower quartile earnings increased by 17% (from 7.25 to 8.49). By contrast
the lower quartile ratio fell by an average of -4% across England and the median ratio
increased by just 1%.
Solihull’s housing market has become more difficult as a result of the economic downturn.
The average house price in Solihull is at £196,000 (January 2012) 21% higher than the
England & Wales average and 52% higher than the West Midlands.
121 3. Housing Need
The pressure on the housing register (the waiting list for social housing) has increased by
94% since April 2008 to 14,742 households at 31 December 2011.
At the 31st December 2011 there were 6,420 households on the Housing Register who were
categorised in the A-E bands and therefore were considered to be in some degree of
housing need as defined by the Council’s Allocations Policy and had a local connection.
51% of the A-E band households with a Solihull postcode were from the North Solihull
regeneration wards – 30% of the entire register. The high number of households in the North
Solihull regeneration wards reflects the number of Council Tenants on the Housing Register
requesting transfers.
Households on Housing Register in Bands A‐E
1,800
Number of Households
1,600
North Solihull 51% of Total
1,400
1,200
1,000
800
600
400
200
0
Source: Solihull Home Options
Outside of the north Solihull Regeneration wards there are a number of neighbourhoods with
75 or more households in bands A-E of the Housing Register, most notably Damsonwood
(Silhill and Elmdon wards), Olton South, Hobs Moat North (Lyndon ward), Green Hill (Shirley
East ward), Marston Green (Bickenhill ward), and Parkfields (Castle Bromwich ward).
4. Traveller Communities Solihull Council is committed to helping meet the accommodation needs of the whole community. As part of the Local Development Framework the draft Local Plan identifies that the borough has a shortage of authorised Gypsy and Traveller sites in Solihull to meet identified needs and will aim to maintain an appropriate level of supply. The Council completed an updated Gypsy and Traveller Accommodation Assessment in February 2012. This identified the need to provide 26 residential pitches between 2012 and 2017. The location of these pitches/sites will be identified through a Gypsy and Traveller Site Allocations Development Plan Document’. 122 on 5. Propeerty Conditio
Housingg conditions in the Cou
uncil and hoousing assocciation secto
or are goodd with all prroperties meetingg the ‘Decentt Homes Stan
ndard’. In the prrivate housin
ng sector the
ere are two i mportant isssues that havve health im plications, 
the demograp
phic trend of a
an ageing poppulation may mean that an increasing nuumber of housseholds are less able tto afford to m
maintain their homes and reequire greaterr assistance too do so. An ageing population allso increases h
hazard in the hhome and thiss is discussed below in ‘Heaalth Related to
o Housing’. 
growth of privvately rented pproperties is rresulting in a g
greater incideence of poor a
and a significant g
hazardous acccommodation
n. While mostt landlords pro
ovide a good sservice requessts to and outtcomes ffrom Public P
Protection worrk suggest thaat more landlo
ords are strugg
gling to mainttain their prop
perties in the current fin
nancial climatte. The Cou
uncil works w
with propertty owners too both advise
e them on how they cann repair and improve their pro
operties and deals with e
enforcementt under legislation where
e necessary. 6. Fuel P
Poverty and A
Affordable W
Warmth Official d
definitions d
define a houssehold to bee in fuel pove
erty if more than 10% off net income
e is spent 
on main
ntaining a saatisfactory heating regim
me. This bein
ng 21 C in th
he main livinng room and
d 18C in other occcupied room
ms. In March
h 2011 it waas estimated that there w
were 13,4699 householdss living in fuel povverty in Solih
hull 15% of the total houuseholds in the borough, a figure thaat as the cha
art below shows h
has been incrreasing over recent yearss. ammes desiggned to incrrease the energy efficienncy of dwelllings it is Despite the existencce of progra
erty numbers as a resu lt of the substantial anticipated that wee will see an increase iin fuel pove
mn 2011. increasee in gas and eelectricity prices announ ced in Autum
123 Fuel poverty is a very significant issue. For example it is considered to be a contributory factor to excess winter mortality. In Solihull excess winter mortality was estimated to be 87 during 2010/11, a reduction from 111 in 2009/10. The 2010 Age UK report “Excess Winter Deaths: Preventing an Avoidable Tragedy” calls for Local Authorities to identify vulnerable people and refer them to appropriate help. This responsibility should run simultaneously with the requirement for the Local Authority to both co‐ordinate the efforts of partners from all local sectors and ensure that advice is available to the most vulnerable residents about help with fuel costs. The report states that between 2003 and 2009, average household gas bills doubled and average electricity bills rose by 60%. Not only does this sit against a backdrop of falling incomes, an ageing population and a deteriorating older housing stock, but the costs for public services are thought to be enormous – for every additional winter death, there are eight admissions to hospital, 32 attendances at outpatient care and 30 social service calls. Age UK also state that relieving cold and debt, could reduce depression by half and visits to GPs by a quarter, and that every £1 spent on keeping homes warm could save the NHS 42p. The Marmot report also argues strongly that ill health and death rates increase in the older population in cold weather with Chronic Heart Disease and Cardio‐Vascular Disease being particularly affected by winter temperature (existing health conditions such as respiratory diseases and asthma are also known to be affected) – the strong relationship between poor insulation and heating of houses, low indoor temperature and excess winter deaths of older people is also stressed. Evidence from the 2009 English Housing Stock Survey supplements Marmot’s findings, as nearly one in three of the households (31.8%) in England where the oldest person is aged more 75 or over live in households which has failed the decent homes standard. One in eight (13.3%) of these oldest households fail this standard because of sub‐standard heating and insulation. It is also shown that older people living in private rented housing are most at risk of living in non‐decent homes (note that this applies to all age groups). Nevertheless, the trends since 2000‐01 for Excess Winter Deaths in England and Wales reveals steady growth only for the population aged under 65 (increasing by 120% over the period to 2010‐
11, from 7% to 15% of the total). The population aged 85 or over is still the group of most concern accounting for 46% of the total at 2010‐11, which consistent with the long‐term proportion of 47%. It should be noted that there are years such as 2008‐09 and 2004‐05 where all age group above 65 rise considerably and so year‐on –year comparisons are difficult – the level for 2010‐11 at 25,700 is relatively unchanged from 25,810 during 2009‐10. 124 40
0–64
65–74
75–84
85+
Excess Winter Death Index
35
30
25
20
15
10
5
0
The challenge of tackling fuel poverty by promoting energy efficiency and ensuring affordable warmth goes across all housing tenures and affects all ages of the population. The Council’s Home Energy and Affordable Warmth Strategy aims to improve the energy efficiency of domestic dwellings in Solihull and reduce fuel poverty throughout the borough. The Council will continue to work with internal and external partners in accessing funding to develop initiatives aimed at improving the energy efficiency of homes and reducing the incidences of fuel poverty. In addition to physical improvements an annual ‘Winter Warmth’ campaign has been in existence since 2008. The campaign has a particular focus to proving timely support and assistance to vulnerable residents including older people, people with disabilities, families with young children and low income households to: 


To provide timely support and assistance to vulnerable residents To provide emergency equipment and assistance when heating breakdown occurs To provide a referral mechanism to a range of services provided by internal and external partners The campaign is organised by a range of organisations including the Council and Age UK Solihull. The Winter Warmth campaign is widely publicised, including a helpline that provides access to a range of advice, information and emergency support. As part of the NHS Cold Weather Plan the Winter Warmth campaign has been awarded £34,750 from the Warm Homes Healthy People Fund. This funding will support the creation of a Cold Weather Plan Lead, to build upon the existing Winter Warmth campaign and develop and deliver the Cold Weather Plan for Solihull working across health, social care, voluntary organisations and local communities, working closely with Age UK Solihull and SMBC. This multi‐agency approach aims to proactively target those most vulnerable working with health practitioners to identify their most vulnerable patients who will be targeted for additional support. A 125 Volunteer Network will be established within local communities to respond to local need and to provide training for front line staff Much of this work will be used in future years to target the most vulnerable and to provide timely information and emergency support. Health Related to Housing The previous government through the Office of the Deputy Prime Minister in 2003 commissioned a study on the links between housing conditions and the health and safety of occupiers. The study identified 29 potential hazards which could be attributable to housing design and/or condition (this excludes hazards such as tobacco smoke that are attributable solely to occupier behaviour). Based on this work, initial estimates suggested that these hazards might be implicated in up to 50,000 deaths and 0.5 million injuries in England each year. The greatest number of deaths, over 40,000, was linked to problems of excess cold because of energy inefficiency. The evidence also suggests that accidents in the home result in more injuries than accidents at work or on the road. 

Energy efficiency, dampness and ventilation Occupancy and amenities 



Crowding and space Entry by intruders Noise Falls associated with lavation Falls on the level Falls associated with stairs or steps Falls between levels Fire Collision and entrapment 
Surveillance, locks and condition 
 Situation and insulation Design 
  Surfaces, disrepair and drainage   Rails   Disrepair and projections    Installation, layout and detectors Design and disrepair 


Fatality Depression/Distress 
Deterioration Infections/Contagion Poor insulation, ventilation and damp proofing Injury Contributing Factors Damp and mould growth Excess cold Cardiovascular Hazard Respiratory A seminal report in this subject entitled, The Real Cost of Poor Housing (BRE, 2010), applied mean Housing Health and Safety Rating System (HHSRS) scores to these factors – the report advises that the estimated cost of remedying category 1 hazards could average only £4,000 per home. The following table highlights the key hazards cross‐tabulated with main related health problems: 
126 The Environmental Protection Team within the Public Protection division of Solihull MBC is responsible for inspecting domestic properties that have been identified as being potentially unsafe. It is anticipated that there is considerable scope for joint working related to housing related activity through the integration of public health within the Local Authority. The following areas are thought to be of most importance: The Housing Act 2004 was designed to bring in a proactive, preventative way of looking at injuries in the home. The idea of risk assessing a home and taking actions to stop accidents or ill health from happening has been shown in many studies to be more cost effective than treating the injury or illness. The key to having a robust and effective injury prevention strategy is to make sure that those resources are targeted to where they can have the biggest effect. This inevitably requires an approach to commissioning that is intelligence driven from the outset and continually evaluates the cost effectiveness of subsequent outcomes. This also requires an end‐to‐end focus on services for patients that mandates partners working together to deliver real collective improvements. ONS data from 2007‐10 reveals that the proportion and number of deaths from external causes that take place in homes and residential institutions has increased across gender: Male Female % count % count 2007 20.7 2,236 27.1 1,794 2008 22.9 2,525 29.4 2,062 2009 24.3 2,721 30.1 2,011 2010 25.3 2,667 31.7 2,109 The following chart reveals the 2010 breakdown for deaths from falls (again in England and Wales) – 86.2% are found to be over the age of 60 (91.5% for females). 100%
90%
219 434 80%
70%
80‐89
70‐79
698 60%
60‐69
812 50%
40%
10%
50‐59
40‐49
375 30‐39
30%
20%
90+
211 144 99 0%
Male
274 20‐29
124 81 50 10‐19
<10
Female
When viewed across secondary care as a whole (England only) around 95% of falls that are typical of the home environment lead to admissions that are classified as emergencies – this proportion is consistent across all of the following types (note that other falls from one level to another disproportionately affect children): 127 Cause Fall on same level from slipping tripping and stumbling Fall involving bed Fall involving chair Fall on and from stairs and steps Fall from out of or through building or structure Other fall from one level to another Other fall on same level Admissions 88,898 21,114 12,065 37,359 5,375 9,086 51,177 Mean Age 67 73 65 57 30 35 70 Forecasts from POPPI suggest that falls for people in Solihull aged 65 and over are expected to increase by 48% from 10,236 in 2010 to 15,102 in 2030. The following table reveals the greatest increase to be in those aged 85 and over who are predicted to have a fall (increasing from 21% of the total in 2010 to 30% in 2030). Falls ‐ all people 65‐69 70‐74 75‐79 80‐84 85+ Population aged 65+ 2010 2015 2,247 2,089 1,742 1,965 2,193 10,236 2,603
2,398
1,872
1,999
2,752
11,624
2020 2,188 2,761 2,129 2,191 3,139 12,408 2025 2030 2,411
2,378
2,505
2,550
3,698
13,542
2,790 2,633 2,156 3,008 4,515 15,102 Increase (%) 24 26 24 53 106 48 A significant number of people over the age of 65 live alone and this presents challenges to services in how best to support the needs of the individual especially if that person has expressed a wish to remain living at home. The expected increase in the numbers of people living alone also needs to be considered against the rise in the numbers of dispersed families meaning that for many, access to support from family members will not be available. Another example of an intervention to prevent injury might be if NHS data shows that children in Smith’s Wood are more likely than anywhere else in Solihull to fall from first floor windows; then the Environmental Protection team could work with partner agencies (eg schools, children’s services etc..) to educate children and their parents about the dangers of first floor windows. It may even be feasible to use the HHSRS technique to target the most dangerous window designs (eg low window sills) and fit window restrictors. A closer relationship between the Local Authority, NHS and GPs could even include GPs making a referral or recommending an HHSRS inspection. For example if a patient presents with bronchitis and the GP learns that they live in a rented property with no heating, damp and mould, and a landlord who is refusing to help – Environmental Protection can ensure that the property is brought up to standard by requiring the landlord to install heating and ventilation. The biggest positive about modifying a property to make it safe, is that the changes are long term: once restrictors have been put on the windows they will be in situ for many years even after a new family has moved into the property. The same is true of the lack of heating or domestic hygiene or uneven flooring. 128 Protection haave arrangements to traain a numbe
er of partne
er agencies ((adult and children’s c
Public P
social seervices, neighbourhoodss teams, Poliice, Fire Servvice, Age UK
K, CAB and SSCH) to spot some of the morre common contributing factors inn home base
ed accidentss. Within tthis context housing interven
ntions are a fundamenta
al part of botth adult and
d children’s ssafeguardingg. Age UK a
also carry out NHSS falls assesssments in pe
eople's homees which include looking
g at medicatiion, trip hazards and alcohol cconsumption
n (also abou
ut to start a fferrule replaccement service to reducee incidents o
of falls in those who use walkiing aids). It should
d be noted tthat section 5 of the Hoousing Act 20
004 states th
hat: “If a loccal housing a
authority considerr that a category 1 hazarrd exists on aany residenttial premises, they must take the app
propriate enforcem
ment action in relation to the hazaard.” This raises an issu
ue regardingg actions concerning owner o
occupiers, as the vast majority m
of Public Prote
ection’s currrent cases aare from the
e private rented ssector. The ffact that secction 5 still pplaces an oblligation on th
he Local Autthority to takke action to alleviate any cateegory 1 hazards that are found could
d impact on other strateegies. For exxample if hen there may m be no chhoice but to prohibit propertiies are so daangerous as to be uninhhabitable; th
parts orr all of someebody’s hom
me – effectiv ely making them t
homeless. Howevver, the law requires Local Au
uthorities to do these things for a goood reason ie that injury p
prevention iss an important public health fu
unction, partticularly in th
he home. Nationally, the privaate rented se
ector has thee highest leve
el of homes iin ‘substantiaal disrepair’ and the o not meet th
he decent hoomes standard. The English Housing SSurvey for 20
010/11 highest level that do
hat 37% of prrivate rented
d homes werre of a non‐d
decent standard in 2010 w
while in the owner notes th
occupieed sector 25%
% failed to m
meet the staandard. Conditions were
e better in tthe social sector, where o
overall 20% dwellings w
were non‐deccent. 129 The proportion of vulnerable people (those on benefits) is also greater in the private sector than in other tenures1. Based on an earlier version of the English Housing Survey, Care & Repair England notes the following2: 


Vulnerable people living in private sector housing are significantly more likely to be living in non‐decent homes (39% non‐decent); Privately owned homes are almost twice as likely to have Category 1 hazards compared to social housing (24% vs 13%); The likelihood of living in a non decent private home is higher for people who are over 75 years, older single women, black and minority ethnic elders and for those who have lived in the same home for more than 25 years. For these groups their home is more likely to fail the decent homes standard on the grounds of requiring urgent repairs ie. those which pose a threat to the health, safety, security and comfort of the occupant or to forestall further rapid deterioration of the building. The Housing and Health report notes that, alongside finance issues (no funding is specifically allocated for private sector in the Decent Homes Programme), there are a number of issues that make it difficult to tackle non‐decent homes across the private sector, including:  Difficulties in communicating/engaging with occupants in the private sector;  The diverse nature of the sector, which makes it difficult to target those most in need of assistance and to implement improvements in a systematic fashion. More specifically, in terms of the private rented sector issues include:  Property maintenance and energy efficiency in this sector are the responsibility of the landlord;  Short tenancies and lack of security of tenure lead to mental health problems and a reluctance on the part of tenants to challenge landlords or take up home improvement schemes. Looking forward, there are concerns that cuts in the Local Housing Allowance (equivalent of Housing Benefit for private sector tenants) may lead to an increase in the proportion of economically vulnerable people seeking low cost accommodation3. This could lead to an increase in overcrowding (a known health risk) and more vulnerable people living in poorly maintained rented housing. In Solihull, there have been an increase in complaints from private sector tenants in the last two years and a 25% increase in Category one hazards comparing 2010/11 with 2011/12. There are a number of likely reasons for this increase:  An increase in the number of private rented properties in Solihull;  An increased awareness in legislation that changed in 2006 this led to a change where many more hazards are now assessed as to the previous general fitness standard. The current HHSRS regime is more comprehensive allowing specific hazards to be identified allowing an officer’s assessment to be more objective; 1
Housing and Health, Parliamentary Office of Science & Technology, January 2011.
Beyond Decent Homes: Decent Housing Standards post 2010, Care & Repair England, September 2009.
3
Chartered Institute of Environmental Health and Shelter
2
130 
Anecdotally it would appear a
that more and more landlo
ords are strruggling to maintain properties d
due to the fin
nancial climaate, which ine
evitably lead
ds to more seervice requests. At the saame time th
he Council faces a numbeer of constraaints in tackling this probblem, particu
ularly the fact thatt all Governm
ment funding for Privatee Sector Ren
newal has ceased and thaat Council asssistance now maainly loans not grants. As A a result thhe Council’s policy objecctive in resp ect of privatte sector housing is to ensure that assistance is prope rly targeted.. Hospitall Episode Staatistics (HES) of in‐patiennt data for th
he Solihull Prrimary Care TTrust during 2010‐11 reveal p
potential concerns arou
und the prooportion of older people (aged 75 or over) who w
have received
d finished co
onsultant episodes. Altoogether there were 20,595 finished consultant episodes (27.6% o
of the total o
of 74,622) – with a norm
malised rate of 97.8 per 1,000 popul ation. Both of these 75 and o
over measurres rank Solihull 137th oout of 151 Primary Care Trusts (notee that the 60
0‐74 rate ranks 1004th [same aas all ages] compared witth 37th for 0
0‐14 and 67th for 15‐59).. HES dataa also showss that in 2010
0‐11 Solihull had 23,477 emergency admissions ((37.6% of the
e total of 62,472).. This is a raate of 111.5 per 1,000 ppopulation an
nd ranks Solihull 102nd oout of 151 P
PCTs (the proportiion emergency admissions ranks 1109th). Although there
e is only a modest co
orrelation nationallly between emergency admissions and older people p
episo
odes, with SSolihull beingg ranked high forr both it posses a questio
on as to whhether having a dispropo
ortionately hhigher popu
ulation of those w
who are veryy old with an
n inherent ddemand on health h
servicces, does th is affect the
e level of emergen
ncies and to
o what exten
nt are thesee preventable
e. Further investigation
i
n should identify the potentiaal for targeteed multi‐discciplinary inteervention an
nd would furthermore am
meliorate the overall need forr services wh
hich are pred
dicted to gro w substantiaally over time
e. Most off the recent increase forr in‐patientss aged 75 orr over was during d
2009‐‐10 (2,926 co
ompared with 331 during 20
010‐11 – the
e impact of ‘Safe and Sound’ home
e checks shoould be considered). Other significant inccreases are ffor those ageed 15‐59 (4,919 over the
e period) annd is thoughtt unlikely to be related to housing: 131 6,000
Increase 2010‐11
Increase 2009‐10
29,989
5,000
Episodes 2010‐11
4,000
20,595
3,000
16,951
2,000
6,904
1,000
0
0‐14
15‐59
60‐74
75+
Volunteering Two questions in the Place Survey measure the extent to which respondents are involved in
their local community by providing either formal unpaid voluntary work (through a group, club
or organisation) or on a more informal basis (through activities such as helping a neighbour
or cleaning the local environment).
Across Solihull 40% of residents indicated that they had participated in some form of formal
volunteering in the last 12 months (24% at least once a month, 16% less frequently). On a
sub-Borough basis those living in the Symbols of Success wards are most likely to have
participated (45%), followed by those in Suburban Comfort wards (39%) and those in the
Regeneration wards (27%).
Segment
Solihull
Symbols of Success
Suburban Comfort
Regeneration
Once a Month
Less Often
Not at All
Total Volunteered
24%
16%
60% 40% 27%
18%
55% 45% 25%
14%
61% 39% 15%
13%
73% 28%
Among those population groups with relatively low levels of participation in formal
volunteering are the unemployed (19%), as well as those dissatisfied with their local area as
a place to live (25%). Respondents from the BAME community are less likely to have
volunteered (32%) than white respondents (41%). On the flipside those working part-time or
in full-time education (who are exclusively under the age of 25) are most likely to participate.
Of those who had not taken part in formal volunteering over the last 12 months 33%
indicated that they had helped out in some other informal capacity over this period, with this
response relatively common among those retired from work and those dissatisfied with their
local area as a place to live.
A total of 47% of respondents indicated that they had provided some form of informal help in
their local community over the last 12 months, with the pattern similar to the response to the
formal volunteering question with relatively low levels of participation among respondents
from the Regeneration wards, those not working and BAME respondents. The main
132 difference is that those aged between 17-24 years who had an above average rate of
participation in formal volunteering were at the lower end of the spectrum in terms of
providing informal help.
In order to increase community participation there is a need to build community capacity
defined as the process of supporting individuals and community organisations to help them
to better identify and meet the needs of their areas. An important aspect of this is increasing
the ability of the voluntary and community sector organisations to provide services or take
action on behalf of the communities or client groups they support. The National Survey of
Third Sector Organisations environment for the 3rd sector measures the environment for a
thriving third sector at a local authority level by addressing contextual questions covering, for
example, the quality of funding relationships and partnership working between the third
sector and local statutory bodies. On this new measure Solihull appears to be performing
relatively poorly and was ranked only 89th out of 92 local authorities and 12th out of 13
members in the CIPFA comparator group of authorities at the end of 2008-09.
Priorities for Commissioning •
Implementation of Anti‐Poverty Strategy and action plan: –
Multi‐agency identification and referral system for advice, information and counselling on debt, employment, welfare, housing, and health; –
Assess implications of Welfare Reforms and provide local assistance/response; –
Tackle fuel poverty through ‘Winter Warmth’ Programme. 133 CreateandDevelopHealthyand
SustainablePlacesandCommunities
Key Findings •
Quality of environment is good (IMD Living Environment). •
Challenges: •
•
–
Community safety and fear of crime (e.g. 26% >65s afraid to go out after dark); –
Anti‐social behaviour; –
Access to essential services (in rural areas) and public transport; –
Traffic both congestion and speed; –
Housing development (LDF). Community Capacity – Assets: –
Community led initiatives (e.g. HELP projects in North Solihull Regeneration area); –
Residents associations; –
Volunteering Bureaux; –
Voluntary Sector. Regeneration programme in North Solihull. Community Safety A recent survey1 asked residents to consider their neighbourhood over the past 12 months
and asked if during this time they had ever felt fearful of becoming a victim of crime. Almost
one fifth of residents in Solihull (18%) said they had worried about being a victim of crime, a
decrease of 4% since the previous survey. However, fear of crime in Solihull remains higher
than the force wide rating of 13%. That said on a personal level exposure to crime in
general, and in particular to violent crime is likely to be detrimental to an individual’s health
and wellbeing. Depression, panic disorder and post traumatic stress disorder have all been
associated with exposure to crime.
The Feeling the Difference Survey does not provide a ward breakdown for fear of crime, so
the nearest proxy is the 2011 Solihull Place Survey in which respondents are asked whether
they feel safe or unsafe in their neighbourhood after dark. Just 18% of respondents from
across Solihull say that they feel unsafe after dark (12% fairly unsafe, 6% very unsafe), with
the proportion falling to just 2% during the day. However, at 32%, the proportion who feel
1
West Midlands Police, Feeling the Difference Survey, July 2010 134 unsafe at night in the Regeneration wards is far higher than the rest of the Borough. This
shows that generally, wards with an above average crime rate are also those where
proportionally more people feel unsafe.
Segment
Solihull
Symbols
of
Success
Suburban Comfort
Regeneration
Very
Unsafe
Perceptions of Safety In Local Area
After Dark
Fairly
Total
Very
Unsafe
Unsafe
Unsafe
During the Day
Fairly
Total
Unsafe
Unsafe
6% 12% 18% 0% 2% 2% 3% 5% 14% 7% 17% 18% 10% 22% 32% 0% 0% 1% 2% 1% 5% 2% 1% 6% There is a clear gender split on this issue with 27% of female respondents feeling unsafe
after dark compared to just 11% of males (although the proportion of females feeling unsafe
during the day falls to 3%). Other groups that appear to feel relatively vulnerable after dark
are older people (with 26% of over 65s feeling unsafe compared with just 6% of 17-24 year
olds), those with a disability (28%) and permanently off work because of sickness or
disability as well as those whose occupation status is described as permanently looking after
the home (23%). Concerns about safety may also be a significant cause of general
dissatisfaction with the local area with 61% of those who are dissatisfied with their local area
indicating they have safety concerns after dark.
Communicating effectively with the public is a vital component of community policing, but
one which comes with conflicting challenges. Balanced and accurate information provision
helps safeguard residents by raising awareness of preventative measures that can help
reduce vulnerability to crime and reduce the fear of crime often arising from inaccurate
perceptions. However, raising awareness of certain types of crime (e.g. car theft or burglary)
and measures that residents can take to reduce their likelihood of becoming a victim can
itself have a negative impact on crime perceptions. In this context reinforcing the message
through positive media that the number of reported crimes in Solihull is falling (by 40%
between 2002/03 and 2009/10), that Solihull is a safe place to live (with a rate per head 11%
below the West Midlands average) and that crime is being tackled at a neighbourhood level
by successful preventative measures is a vital counter-balance. Reducing the fear of crime
in this manner can have wide ranging benefits including preventing isolation and its
consequences for health and well being, as well as enhancing community cohesion and
participation. It is perhaps worth noting the finding from the Place Survey that illustrates
potentially the largest gap of satisfaction with services between the Symbols of Success and
Regeneration wards being in parks and open spaces (87.5% compared with 62.0%
satisfied). This could be considered from both a safer and access lens but nonetheless is an
important issue, as the benefits of parks and green spaces regarding mental and general
health are well documented.
Anti-social behaviour (ASB) is recognised as influencing a range of community issues
including perceptions of cohesion, feelings of safety and willingness to participate in the
community activities. When asked about ASB in their local area most respondents to the
survey felt that levels had remained the same over the last 12 months (72%), with a roughly
equal split between those who felt it had reduced (13%) and got worse (15%). Although a
135 higher proportion of respondents from the Regeneration wards felt ASB had got worse (19%)
over the last year than elsewhere in the Borough, this area actually has the most positive
balance on this measure due to an above average proportion stating that ASB has fallen
(21%).
When asked about a range of ASB issues in their local area 46% or respondents indicated
that there was a problem with at least one of eight listed types of ASB, with 21% of
respondents reporting a problem with more than one type and 4% with four or more issues.
Across Solihull the most commonly cited problem was with rubbish or litter lying around
(27%), with vandalism, graffiti & deliberate damage, gangs hanging around the streets,
people using or dealing drugs and uncontrolled animals or dog mess all cited by at least
20% of respondents. Noisy neighbours or loud parties was the least frequently cited problem
(11%).
Solihull Responses to ASB Issues
Type of ASB
Not a Not a very problem at all big problem A fairly big problem A very big problem Total
Problem
Noisy neighbours or loud
parties
70% 20% 7% 4% 11% Gangs hanging around the streets 50% 24% 18% 8% 26% 42% 31% 16% 11% 27% 44% 30% 19% 8% 27% 55% 21% 16% 8% 24% 54% 29% 12% 6% 18% 52% 25% 15% 9% 24% 59% 23% 13% 6% 18% Rubbish or litter lying
around
Vandalism, graffiti and
other deliberate damage
to property or vehicles
People using or dealing
drugs
People being drunk or
rowdy in public places
Uncontrolled animals or
dog mess
Vehicle nuisance, like
joyriding, abandoned cars
Respondents from the Regeneration wards are far more likely to say that their local area has
a problem with each of the surveyed ASB issues, with over 50% of respondents from this
area citing a problem with rubbish & litter lying around (53%), people using or dealing drugs
(53%) and gangs hanging about the streets (50%). This is consistent with the pattern of ASB
incidences in the Borough.
136 In terms of population groups those out of work, living in socially rented housing and those
generally dissatisfied with their local area as a place to live all significantly more likely to
report each of the issues than the population as a whole. One notable feature is that retired
people/those over the age of 65 are among the least likely groups to say that there local
area has a problem with a particular type of ASB.
39% of all reported ASB in Solihull for the 12 months to November 2011 was within the
North Solihull Regeneration wards, with the average rate per 1,000 population at 77.8 being
178% higher than the rest of the Borough (28.0). The overall Solihull average rate is 37.2
137 which compares favourably with the West Midlands 51.2 and England 59.0 (though note
both are for the 12 months to March 2011). St Alphege and Bickenhill are the only wards
outside the regeneration wards with a higher rate than Solihull as a whole, which is due to
the contained ASB generator hotspots of Solihull Town Centre, NEC and BIA.
ASB Rates in Solihull (Nov‐11)
Rate per 1'000 Population
120
Regeneration Wards
100
80
Solihull Average
England Average (Mar‐11)
60
40
20
0
The Citizens Panel from winter 2010 reveals that ASB is significantly less likely to be seen to
be getting worse in 2010 compared with 2006 and 2008 (13% compared with 31% and 22%
respectively). Overall 61% of respondents see ASB as a problem compared with 77% in
2008 but there are some notable differences in age with 70% between the ages 30 and 44
perceiving it is a problem compared with 55% from ages 60 to 84. There are some
interesting shifts in focus with local shops less likely to be seen as a typical “type of place”
that attracts ASB (from 52% in 2008 to 42% in 2010) but parks more likely (from 38% to
41%). The Panel results also suggest that the nature of ASB may be intensifying
(intimidation/harassment up from 36% to 40% while rowdy behaviour is down from 41% to
34%).
A higher proportion of respondents indicated that more patrolling police was the way to
improve ASB, although the overwhelming majority (77%) still think that there is a role for the
community in reducing ASB. This is supported by the findings of the BMG Community
Cohesion Survey which showed that a high proportion of Solihull residents would take
responsibility for reporting various types of criminal behaviour and ASB to the police or the
council.
Community cohesion is a key factor in building sustainable and inclusive communities. In
this respect the key the Place Survey provides some useful insights, asking respondents
whether they feel that people from different backgrounds get on together well together in
their local area.
Across Solihull 88% of respondents agreed that people from different backgrounds get on
well together in their local area (33% definitely agree, 55% tend to agree) compared to 12%
who disagreed. This positive balance of 76% varies by socio-economic group with the
Symbols of Success wards (80%) significantly higher than the Regeneration wards (65%).
138 At a ward level Blythe and Shirley South have the highest positive balances (94%),
contrasting with five wards that have balances below 70%; Castle Bromwich (68%), Smith’s
Wood (66%), Shirley West 66%), St Alphege (64%) and Chelmsley Wood (55%).
Segment
Solihull
Symbols of Success
Suburban Comfort
Regeneration
Definitely
Agree
33% 39% 30% 26% Tend
Agree
55% 51% 59% 56% to
Tend
Disagree
7% 4% 6% 10% to
Definitely
Disagree
5% 7% 5% 7% Balance
76% 80% 78% 65%
The most negative view of community cohesion is provided by those who have stated that
they are dissatisfied with their neighbourhood as a place to live, with 30% of respondents
from this group disagreeing that people from a different background get on well together
(24% strongly disagree). Respondents who are unemployed or who are permanently off
work through sickness or disability are also at the lower end of the spectrum on this
measure.
Regenerating North Solihull Solihull is one of the most economically polarised boroughs in the UK, with stark differences between outcomes experienced by residents of North and South Solihull. Whilst the majority of the south is affluent, with high educational attainment, low levels of worklessness and high life expectancy, areas of North Solihull have consistently featured some of the most deprived wards in the UK. To tackle these disparities the North Solihull Partnership (NSP) was formed in 2005, which comprises of SMBC, Sigma Inpartnership (programme management & village centre development partner), WM Housing (Consultation & Affordable Housing Delivery Partner) and Bellway (Housing Development Partner). Together they signed up to deliver 15‐20 year’s of holistic and sustainable regeneration designed to make a noticeable improvement to the lives of local people, in respect of housing choice; education; health; employment and the physical environment. Over the lifetime of the project the programme aims to:  Change approximately 40,000 people’s lives for the better;  Invest circa £1 billion of public and private investment over 15 years;  Invest £950 million in social and public assets across the area;  Build up to 5,903 new modern homes;  Build new state of the art primary schools for all children;  Create 5 vibrant village centres to deliver key services – initially to be developed in Craig Croft and North Arran Way 139 However, the Regeneration Programme is not just about physical regeneration. It is also about the regeneration of local communities and developing the capacity of local people to actively engage in the changes that are taking place and ultimately take a lead in making change happen. The North Solihull Regeneration Programme is underpinned by Partnership working and it is the key to making this project a success both in terms of physical and community regeneration. The NSP primarily works in partnership with local communities through a series of Resident Implementation Groups (RIGs) that have a specific regeneration focus and emerging resident‐led partnerships, which have a wider neighbourhood and community agenda. This is in addition to community and consultation events that are held at various points in the delivery of the programme. The focus now is on developing and equipping local people work with partner agencies to bring forward change in their community will help sustain the benefits of the regeneration programme into the future.
Accessibility Sustainable, safe and convenient transport access supports a wide range of policy
objectives. Economically it is vital, supporting economic growth and new investment and at
the same time, through affordable public transport, providing residents with access to
suitable employment opportunities. Public transport also plays a major role in promoting
social inclusion providing some of the most vulnerable residents with access to services,
community and leisure facilities and ensuring that new housing development is adequately
served by non-car modes. By supporting active modes, such as walking and cycling, the
Local Transport Plan contributes to wider health promotion initiatives and helps reduce
carbon emissions. Transport policy behaviour-change programmes also aim to encourage
people to shift their transport choices towards walking and cycling such as 20 miles per hour
(mph) limits. Potential benefits could include more physical activity, less traffic noise and
better air quality. These benefits can lead to reductions in obesity, diabetes, heart disease
and mental health conditions.
The 2010 IMD provides a useful starting point for understanding accessibility issues in
Solihull through the barriers to access to housing and services domain. This captures
distance to key local amenities and services (GP, school, food store, post office) as well as
access to the housing market through measures of overcrowding, homelessness and
affordability.
This is the only IMD domain in which relative deprivation is concentrated in south Solihull,
particularly in the rural east of the borough. Three LSOA are in the bottom 10% in the
country (Chadwick End, Meriden East and Coppice) all of which face issues of access to
amenities and services. However, it should be noted that these are relatively sparsely
populated areas of the borough.
140 More detailed insight is provided by The Solihull Strategy Accessibility Study (Mott
MacDonald, March 2010) which reviews accessibility by walking, cycling or public transport
to a range of key services and facilities identified in Government guidance as having the
most impact on life chances: access to health, education, fresh food and employment. As
the composite map below shows access to these services varies across the Borough,
although it should be noted that areas with low or partial access (20 to 40 minutes by noncar mode) are largely confined to sparsely populated rural areas. Within rural Solihull, the
major village centres (Dickens Heath, Knowle, Balsall Common, Hampton in Arden, Meriden
etc.) are at least within 10 to 20 minutes of key services by walking, cycling or public
transport. However, it is recognised that groups including children and young people, older
people and those with a disability face accessibility problems, compounded by the relative
infrequency of some bus services.
It should also be noted that the Local Authority have been examining how to increase
walking and cycling, leading to decreased congestion and air pollution through Smarter
Routes. This approach looks at barriers the public face when trying to make more
sustainable and healthy transport decisions so that the best options to tackle traffic
congestion, improve journey times and reliability, enhance road safety and improve
pedestrian facilities are taken. Smarter Route studies have been undertaken on the
Warwick Road, Stratford Road, Chester Road and Coventry Road.
141 The Mott MacDonald study adopts a slightly different methodology for mapping accessibility
to employment, as it is important to identify both where in the Borough new residential
development would be best located to readily access employment opportunities, as well as
where new employment should be so that the existing population is able to access it by
sustainable transport modes. Analysis shows that several of Solihull’s large employment
sites (including Birmingham Business Park and the NEC) are not located in the Borough’s
most accessible locations in terms of employee catchment population (coloured green in
map below). This creates some challenges in relation to employment access for residents of
North Solihull in particular. A combination of factors including relatively low car ownership
(average car ownership in Chelmsley Wood was 0.72 per dwelling at the last Census
compared with 1.63 per dwelling in St Alphege – overall 43% of households in North Solihull
do not have access to private transport), less convenient public transport services and the
cost of access to transport for those not in work or in low paid employment, creates some
equality issues around access to employment among North Solihull residents. There are a
number of schemes designed to alleviate these inequalities including Workwise which
provides funding for those out of work attending interviews and in those in the early stages of
new employment. Also, it is recognised that local government planning can promote healthy
communities by creating an environment which encourages active transport choices. There
is good evidence that urban design and land use regulations, policies and practices can be
effective in increasing walking and cycling, particularly in mixed land use, high-density areas
and by improving pavement quality and connections. Redesigning places with people in
mind, through better connected walking routes, car-free cycling routes, community green
spaces, improved lighting and enhanced aesthetics are examples of positive initiatives that
increase the number of physically active people. In order to complement the various
sustainable transport initiatives associated with the regeneration of North Solihull the Council
proposes to create a £2 million North Solihull Cycle Network to link the area with BIA and the
NEC.
142 In summary some of the key transport accessibility issues in Solihull are:










There are significant areas of Solihull (and the wider journey to work area) where access
to employment is difficult in particular for those people who don’t own or have access to
a car. Several large employment sites are difficult to access without a car.
There are significant areas of Solihull that are not within easy walking distance of a food
shop, a primary school or a GP.
Many residential areas are affected by cars driving at speeds which discourages walking
and cycling and the use of streets for social contact.
Parts of Solihull are already affected by congestion in particular during peak periods and
therefore capacity of our local highway network to carry more cars is limited. The
increase in travel demand as a result of economic growth has therefore largely to be
accommodated by an increase in the use of walking, cycling and public transport.
A lack of physical activity both amongst adults and children causes health problems such
as obesity.
Transport accounts for approximately 28% of UK domestic carbon emissions (excluding
international aviation and shipping). Within Solihull street lighting amounts to approx.
20% of SMBC emissions and vehicular transport for approximately 10% of SMBC
emissions.
There are still locations where accidents are a cause for concern.
All existing and new communities need access to employment and local services. We
also need to consider communities out side Solihull who work in Solihull access.
Businesses need employees to be able to get to work on time and to move goods
efficiently and reliably.
Car ownership (2000 census) in North Solihull is significantly lower than in south Solihull.
For example average car ownership in Chelmsley Wood was 0.72 / dwelling and in St
143 


Alphege 1.63 per dwelling. This factor and the location of employment areas makes it
more difficult for people in north Solihull to access employment.
The rural part of Solihull has limited bus services and although car ownership is relatively
high (1.66 average/dwelling) groups such as young people and the elderly have
restricted access to services and employment.
Concern about children using roads where cars are travelling above around 20mph limits
their opportunities for exercise such as walking and cycling to school. There are two groups which have higher levels of accidents and these are the under 24
male drivers and the over 60’s. Local Development Framework The Local Development Framework (LDF) draft Local Plan Proposed Submission Document sets out the long‐term spatial vision for how the Borough will develop and change over the Plan period to 2028 and how this vision will be delivered through a strategy for promoting, distributing and delivering sustainable development and growth. When adopted, it will replace the adopted Solihull Unitary Development Plan 2006. The draft Local Plan sets out how the Council will allocate sufficient land for 4,040 net additional homes to ensure sufficient housing land supply to deliver 8,930 additional homes in the period 2011‐
2028. The allocations will be part of the overall housing land supply. The annual housing land provision target is 525 net additional homes per year. A trajectory showing how this target will be delivered from all sources of housing land supply Is included in the Strategic Housing Land Availability Assessment and will be subject to annual review. The housing sites are phased to ensure a continuous supply of housing provision throughout the Plan period and a continuous supply of affordable housing. Sites will not be released for development before they reach their specified phase, unless existing housing land supply falls below five years and the annual monitoring process has reviewed site deliverability and indicates that the trajectory is unlikely to recover over the next five years without additional land releases. New housing will be supported on unidentified sites in accessible locations where they contribute towards meeting identified borough‐wide housing needs and towards enhancing local character and distinctiveness. Unless there are exceptional circumstances, new housing will not be permitted in locations where accessibility to employment, centres and a range of services and facilities is poor. The density of new housing will make the most efficient use of land whilst providing an appropriate mix and maintaining character and local distinctiveness. Higher densities will be more appropriate in the most accessible locations. Development briefs will be prepared for each site in consultation with communities and developers and will set out the Council’s expectations for the development of each site. Each brief will provide criteria and principles for development. Development briefs will be a material consideration in planning applications and will inform pre‐application discussions. Development will be expected to meet the following accessibility criteria, unless justified by local circumstances. Proposed housing development should be; 
Within an 800m walk distance of a primary school, doctor’s surgery and food shop offering a range of fresh food; and 144 
Within a 400m walk distance of a bus stop served by a commercial high frequency bus service (daytime frequency of 15 minutes or better) providing access to local and regional employment and retail centres Investment in improvements to local public transport provision, cycling and / or walking measures will be sought in association with development proposals which do not meet the accessibility criteria set out by this policy. Access to development from the core walking, cycling, public transport and road networks will be expected to be: 

Safe, attractive, overlooked and direct on foot, by bicycle and from public transport; Safe for those vehicles which need to access the development; and 
Assessed in accordance with Policy P15 ‘Securing Design Quality’ in the Local Plan The potential for achieving positive health outcomes will be taken into account when considering all development proposals. Where any adverse health impacts are identified, the development will be expected to demonstrate how these will be addressed or mitigated. The Council will expect new development proposals to promote, support and enhance physical and mental health and well being. Support will be given to proposals which: 







Provide opportunities for formal and informal physical activity, exercise opportunities, recreation and play; Contribute to a high quality, attractive and safe public realm in accordance with Policy P15 Securing Design Quality, to encourage social interaction and facilitate movement on foot and by cycle; Contribute to the development of a high quality, safe and convenient walking and cycling network; Improve the quality and quantity of the green infrastructure network in the Borough, particularly in the North Solihull Regeneration Area and in areas where green infrastructure is identified as lacking. The protection and enhancement of physical access, including public rights of way to open space and green infrastructure will also be supported; Deliver new and improved health services and facilities in areas where they can be accessed by sustainable transport modes. Facilities for primary medical care should be identified and planned for; Increase access to healthy food by sustainable transport modes and provide opportunities for growing local produce. The Council will resist the loss of areas which currently enable local produce to be grown; Provide additional homes which are designed to meet the needs of older people and those with disabilities, and housing which enables older people to downsize from larger homes; and Improve the energy efficiency of housing. New residential development will be expected to be built to the Lifetime Homes standard in accordance with Policy P15 Securing Design Quality, to ensure that homes are adaptable and enable people to live independently for longer. All developments should maximise internal insulation and opportunities for solar gain and wherever possible, developments should also seek to incorporate private amenity space. Development proposals should incorporate planting, trees, open spaces and soft surfaces wherever possible in order to secure a variety of spaces for residents, visitors or employees to use and observe. The loss of community and social infrastructure will be resisted unless it can be demonstrated that: 

It can no longer continue for commercial or operational reasons; There are identified benefits of the use being discontinued; 145 
Adequate alternative provision can be made in a manner which meets the needs of the community affected. The Council will resist development proposals for hot food takeaways in areas where there is already a high concentration of such uses. Sustainability and Climate Change One of the strengths of Solihull as a Borough is that, in general, it offers an attractive living
environment, characterised by good quality housing and accessible Green Space. There
are, however, local inequalities that impact of the lifestyles of specific population groups.
The IMD Living Environment domain provides a useful starting point for measuring the
quality of the physical environment in Solihull. This domain is derived from four indicators:
social and private housing in poor condition; houses without central heating; air quality; and
road traffic accidents causing injury to pedestrians and cyclists and as such captures
evidence relating to both indoor and outdoor conditions in Solihull.
Overall Solihull is subject to relatively low levels of living environment deprivation, with 85
LSOAs (64% of total) in the least deprived 50% nationally and only 3 LSOAs (2%) in the
most deprived 25% in the country. The most deprived LSOAs from a Living Environment
perspective in Solihull (Coventry Road East, Elmdon Park South and Hobs Moat North) form
a cluster in the Lyndon and Elmdon wards and are subject to relatively poor local air quality.
IMD Living Environment Domain
Percentile
0 - 5th (Bottom 5%)
5 - 10th
Elmdon
Park South
Chester Road East
10 - 20th
20 - 30th
30 - 50th
Hobs Moat North
50 - 75th
75 - 90th
90 - 100th (Top 10%)
Source: Index of Multiple Deprivation 2010
Despite the existing strength of the living environment in Solihull, the impact of climate
change and the responses to this will be critical in securing a healthy environment in the
future.
146 Carbon emissions come from a range of domestic and business/organisational sources,
including transport, heating and lighting. The resulting climate change will affect human
health, the natural environment and cause damage to buildings/ infrastructure, negatively
affecting the quality of life, economy and local public services in the UK. Climate change
strategies must therefore address both mitigation of climate change (the causes) and
adaptation i.e. assessing and reducing vulnerability to climate change and extreme weather.
With a high density of commercial and industrial activity, a large number of dwellings and a
target of up to 8,400 net new dwellings by 2026 (emerging Core Strategy) Solihull faces
significant challenges in terms of energy consumption and emissions. Solihull is ranked in
the highest 50% of Local Authorities in England (52nd percentile) in terms of per capita CO2
emissions from all sources and in the highest 30% for domestic emissions (71st percentile),
with a rate of 2.46 tonnes CO2 per head compared with the West Midlands average of 2.282.
National research indicates that all members of the community will be affected by climate
change but the impacts of climate change will have a disproportionate impact on the most
vulnerable members of our community, in particular elderly people and those with
existing/chronic health problems (further aggravated in areas of deprivation) who may be
physically, financially and emotionally less resilient to the effects of climate change5. This is
particularly pertinent given Solihull’s ageing population.
“Climate change is the biggest global health threat of the 21st century”3. Under a high
emissions scenario a rise in average summer temperatures could result in an increase of 2%
in seasonal all cause mortality. Under this scenario respiratory admissions, food and water
borne diseases, hay fever and allergies and cases of skin cancer are among the health
conditions expected to rise4.
The impacts from increased flooding will be wide ranging and felt most by the most
vulnerable. The social impacts of flooding (e.g. emotional loss) are more damaging than the
material. “The trauma of being flooded and its immediate aftermath was the most significant
intangible impact, disproportionately felt by the elderly and most vulnerable.”5
Financially it is more cost effective to act now. The social, environmental and economic
costs of climate change could be huge if no global action is taken to reduce emissions. The
Stern Review (2006) concludes that while there will be significant costs for individuals,
organisations and the public sector associated with action, the costs of adapting to more
extreme climate change in the future will be greater.
Key local strategies and interventions aimed at mitigation and/or increasing resilience to a
changing climate include:

The Home Energy Efficiency and Affordable Warmth Strategy 2009 which guides the
Council and partner agencies in committing resources to improving the energy
efficiency of domestic dwellings and reducing fuel poverty throughout the Solihull.
2
NI 186 – Department of Energy and Climate Change Costello et al 2009 The Lancet: Managing the health effects of climate change 4 Health Effects of Climate Change in the West Midlands 2010 5 Scottish Executive 2007 – Exploring the Social Impacts of Flood Risk and Flooding in Scotland 5 Older People and Climate Change: the case for better engagement, LGiU/Stockholm Environment Institute 3
147 Domestic dwellings account for almost half of the UK’s carbon emissions so
improving the thermal efficiency of homes is a policy priority with the ultimate goal of
carbon neutrality in newly built properties.

SMBC has a Climate Change Strategy, Carbon Management Plan and policy
documents such as a Corporate Energy Policy and Action Plan for Council Buildings
and Schools.

Local Development Framework and Local Economic Assessment.
In addition a number of organisations have climate change policies, carbon management
plans and targets and green travel plans, however there is no overarching borough wide
climate change strategy or target or co-ordinated approach to emission reduction.
Although there are no Air Quality Management Areas in Solihull (largely due to the rural and
suburban nature, with few dwellings near to busy roads or junctions) because there are no
predicted exceedances of standards at receptor locations, there are hot spots of poor air
quality - no sensitive or inappropriate developments (that might make pollution worse)
should take place in these areas, although it is thought that the environmental impact
associated with development is adequately assessed and controlled. Furthermore, Solihull
MBC is working with the other West Midlands Metropolitan Authorities to develop low
emissions strategies for vehicles, especially large diesel engine vehicles like buses and
lorries. This includes encouraging the use of cleaner vehicles rather than penalising dirty
ones, a London style low emission zone is not presently envisaged. It should be recognised
that nationally DEFRA have acknowledged a long term increase in ground-level ozone from
38 µg m-3 in 1987 to 58 µg m-3 in 2011. Health effects can include respiratory symptoms and
inflammation of the airways.
Solihull’s key strategic sites (which include Birmingham International Airport [a Control of
Major Accidents site due to the amount of fuel stored], the M42 corridor and the Land Rover
plant [an A2 environmental permit site due scale rather than potential toxicity of any
emissions produced]) are a significant influence on several areas being affected by noise
pollution levels above 55 db(A). Defra Noise Mapping data highlights in particular the
transect heading north-west from Balsall Street (including Barston/Eastcote, Bickenhill,
Marston Green, Chapelhouse and Castle Bromwich Hall), Monkspath/Hillfield (East) and
Copt Heath, and Collector Road corridor (Castle Bromwich, Smith’s Wood, Bacons End and
Chelmsley Wood East [see map below]) – note that the industrial noise from Land Rover is
contained within the area of the plant. There are other areas potentially affected by rail
which include Olton, Ulverley Green, Hillfield, Dorridge and Marston Green.
148 Alongside the resp
ponse to cliimate chang
ge and polllution (note that Solihuull only has one A1
site reg
gulated by th
he Environm
ment Agenccy which is the compos
sting site onn the bound
dary with
h there are a number of potentia
al contaminated land ssites, mainly where
Coventrry, although
housing
g has been built on his
storic tips), cconserving and enhancing Solihu ll’s natural heritage
for futu
ure generattions and using reso
ources prud
dently are central gooals of sus
stainable
develop
pment (deve
elopment th
hat meets tthe needs of
o the present withoutt compromising the
ability o
of future gen
nerations to
o meet theirr own needs
s). Current developmeent places to
oo much
stress on resourcces and en
nvironmenta
al systems (water, land and airr). Key asp
pects of
sustaina
able develo
opment em
mphasise th
he wide ran
nge of social, commu nity and ec
conomic
benefitss:




Environmen
ntal assets
s and the b
built enviro
onment: ma
aintain a seense of pla
ace and
identity, ma
aking Solihull a place where peo
ople want work
w
and vissit and bus
sinesses
want to gro
ow and invest (vital com
mponent of Solihull’s co
ompetitive aadvantage)..
Biodiversityy: has intrin
nsic value a
and enriches
s our lives. Also has aan importan
nt role in
improving health
h
and education o
outcomes, reducing
r
crime and im proving com
mmunity
cohesion and social in
nclusion.
gnising the importance
e of design, materials aand pattern
n of land
Heritage asssets: recog
use in the built
b
environment can enable us to
t better un
nderstand thhe appropriiateness
of proposed
d developm
ment.
Sustainable
e consumpttion and prroduction: im
mportant to
o reduce th e inefficient use of
resources which
w
are a drag on th
he economy; helps bo
oost businesss competittiveness
and break the
t link betw
ween growtth and envirronmental degradation
d
. 149 

Narrowing the gap and North Solihull Regeneration: the poorer quality of both the
built and natural environment makes North Solihull less attractive to investors,
increasing the challenges faced by workless people in the area. Improvements to
both the built and natural environment are fundamental to closing the gap of
inequality and the regeneration of North Solihull. There is potential to strengthen the impact of Public Health by working with the
regional team of the Centre for Radiation Chemical and Environmental Hazards
(CRCE) of the Health Protection Agency to ensure health representation on local
Pollution and Contaminated Land groups.
The local authority works closely with Birmingham International Airport to ensure that the
effect of aircraft noise is mitigated as far as possible. It has already been noted that HS2 is
likely to be a significant issue over the coming decade, including construction noise in the
first instance (the Yorkminster Drive area along the eastern edge of Chelmsley Wood is
anticipated to be the most likely substantial affected area of housing within Solihull).
Biodiversity is being lost at an ever-increasing rate - UK has lost over 100 species during the
last century, with many more species and habitats in danger especially at the local level.
Parks and open space are known to improve the health and wellbeing of local resident’s,
support inward investment and regeneration and provide training and volunteering
opportunities. Regular contact with green space is associated with higher levels of physical
activity and reduced likelihood of obesity. But 69% of adults do not do enough physical
activity, less than a quarter of people eat the recommended amounts of fruit and vegetables
and as many as 15.8% of children, 23% of adult men and 29% of adult women in the West
Midlands are obese.6 People with very good access to attractive and large public open
spaces were 50% more likely to have high levels of walking (at least 6 sessions per week).7
The strong correlations between poor quality and quantity of spaces in deprived areas, and
the low levels of physical activity of residents, strongly suggest that investing in the quality of
parks and green spaces is an important way to tackle inequalities in health and well-being
(with ethnic minorities particularly poorly served)8.
Smaller local sites (defined as sites over 2ha within 300m of the home) are very important
for all members of the community, particularly as these sites are within walking distance,
therefore are valuable for children and young people, the elderly and those without easy
access to private or public transport. Being within 300m of green space is key for improving
both physical and mental health. People who live within 500m of accessible green space
are 24% more likely to meet recommended levels of physical activity. Reducing the
sedentary population by just 1% could reduce UK morbidity and mortality rates valued at
£1.44 billion (Defra, What nature can do for you, 2010).
6
West Midlands Regional Assembly Forestry Commission: Economic Benefits of Accessible Green Spaces for Physical and Mental Health, 2005. 8
Cabe 2010 – Urban Green Nation: Building the Evidence Base and Community Green: Using Local Spaces to Tackle Inequalities and Improve Health. 7
150 The distribution of neighbourhood sites is reasonable throughout the urban areas and larger
villages, although there are some notable gaps in provision such as:









Smith’s Wood
Craig Croft
South of Olton
North Silhill/Elmdon Heath
Shirley – east of the Stratford Road, around the Blossomfield/Sharmans Cross area
Dickens Heath – in the north
Knowle – in the east
Balsall Common – to the south
Meriden (south-west)
There is no provision at this scale at all in Cheswick Green or Hampton in Arden. Solihull’s
Green Spaces Strategy identifies deficiencies in local provision in terms of greenspace and
uses of spaces e.g. playgrounds, allotments, playing fields etc. There are deficiencies within
every zone as described within the Zone Action Plans.
Data from the Department for Energy and Climate Change show that in 2009 the average
ordinary domestic consumption of electricity range from 5,054 KWh in Meriden Villages to
3,755 KWh in Hatchford Brook & Elmdon Park, a difference of 35%. At an MSOA level there
is a clear pattern with rural locations and more affluent parts of the urban west of the
borough (e.g. Solihull Central and Monkspath) having considerable higher levels of domestic
electricity consumption than the North Solihull Regeneration Area and less affluent parts of
the south (e.g. Hatchford Brook & Elmdon Park)
A similar pattern is evident in respect of gas consumption, although the gap between the
highest average level of consumption (Solihull Central at 24,314 KWh) and the lowest
(Chelmsley Wood North at 10,355 KWh) is significantly wider (134%) than the range for
electricity consumption. This reflects both the household income inequalities and differences
151 in the housing stock; parts of the urban west and rural Solihull tend to have larger houses
that consume more gas for heating than the North Solihull Regeneration Area and less
affluent parts of the south.
Community Capacity In Solihull the broad objective to empower local communities is especially relevant as the
Solihull Partnership has already recognised that it is vital to ensure that public services are
shaped by, and meet the needs of, all our communities. An engaged and empowered
community is one which has the confidence and capacity to articulate its needs effectively
and the enthusiasm to participate in both local democracy and volunteering projects.
Furthermore, co-production projects between public sector bodies and the community can
improve quality of life and the way local people perceive their area. To this end the Solihull
Partnership has been piloting different approaches to community engagement through for
example the Smiths Wood Area Neighbourhood Network (SWANN), Community Action in
Fordbridge (CAFÉ) and the Locals in Kingshurst (LinK) The SWANN project, which is
working with local service providers to tackle issues (the environment, community safety,
community facilities, regeneration and transport) identified by residents at a listening event,
has been instrumental in developing a framework of critical success factors for community
engagement, including:
o
Building relationships and trust between local residents and local service providers;
o
Being locally responsive (e.g. tackling the things that people are saying are important);
o
Securing some early wins so that people can see something positive happening which will
encourage more people to join in;
o
Providing appropriate support and skills training to enable residents to grow in confidence
and capacity.
152 Another local initiative that will provide opportunities under the localism and Big Society
agenda are the two Volunteering Bureaux (one in Chelmsley Wood Town Centre and one in
Solihull Town Centre) which will come into effect in April 2011 and be operational by October
2011. These will specifically attempt to address Solihull’s relatively low levels of formal
volunteering and alleviate some of the problems in recruiting volunteers cited by local
organisations in the National Survey of Third Sector Organisations (30% of organisations in
Solihull say that there were insufficient volunteers to meet their objectives in 2008).
These initiatives are vitally important because community participation and social isolation
are key factors and acts to protect cognitive decline and dementia in older people, aid the
recovery of those who fall ill, and can reduce the incidence of stress and depression for
those with young children – those who are socially isolated are considerably more likely to
die prematurely than those with strong social ties. Social networks and participation are
found to be less affected by social gradient than the factors in the table highlighted above
and appears to agree with the geographic spread of Unconfident Fatalist segment within the
Healthy Foundations analysis for Solihull (although residents in deprived areas typically
volunteer less, have less trust in others and perceive their neighbourhoods to be less safe).
Furthermore, this supports the asset approach which asserts that when practitioners begin
with a focus on what communities have (their assets) as opposed to what they don’t have
(their needs), a community’s efficacy in addressing its own need increases:
•
Familiar approaches, focusing on problems, deficiencies, design services to fill gaps
and fix problems and so become self-perpetuating where people become passive
recipients of expensive services.
•
Remove barriers to community participation and action, whilst simultaneously
reducing social isolation.
•
Working in a community-led, long-term and open-ended approach, people become
agents in their own and their families’ lives.
•
A mobilised and empowered community may not choose to act on the same issues
that health services and their partners see as the priorities.
•
The aim is to achieve a better balance between service delivery (including
investment in services and tackling the structural causes of health inequality) and
community building.
•
Commissioning must provide activities that support community development and
community building
Priorities for Commissioning •
Implementation of evidence based community regeneration programmes, community empowerment and engagement and capacity building; •
Exploit housing development programme to maximise opportunities for social housing, improvements to quality of the environment and health/wellbeing; •
Ensure developments are sustainable and contribute to carbon reduction targets; •
Reduce homelessness. 153 StrengthentheRoleandImpactofIll
HealthPrevention
Key Findings •
Life expectancy has increased for all communities however it has increased at a faster rate in the most affluent sections of the community; recently the gap in life expectancy has reduced in men but not in women; •
Heart disease, stroke, and cancer are the major causes of premature death; levels in Solihull compare favourably when benchmarked against similar populations; and have consistently fallen; •
Unhealthy lifestyles are risk factors for these illnesses, particularly smoking, poor diet and lack of physical activity; •
Smoking is the single most preventable cause of ill health and yet one in five people continue to smoke; the addiction usually starts in young people and prevalence is greatest at age 20‐24 years; •
Obesity and poor quality diets are contributing to increasing levels of poor health and long term conditions such as diabetes; •
Obesity levels (22% in men; 24% in women) are similar to the national average however are predicted to increase in the future; 10% of Reception children and 18% of Year 6 children are obese; •
Physical activity reduces during the school years, particularly in girls; •
Drinking alcohol hazardous to health is common (37% men; 16% women; equivalent to 33,000 Solihull residents); causing health, mortality, hospital admission, economic and social disorder problems; •
550 adults are currently in treatment for illegal drug addiction (estimated need = 1008); the most common illegal drug is heroin (4/5ths); cannabis and alcohol are the most common in young people; •
Long term conditions are common particularly in older people; they are more prevalent in deprived communities, e.g. heart disease, stroke, diabetes, lung disease; •
Long term limiting illness is reported by 20% of the population in some areas; •
Predictive modeling indicates that GP recorded prevalence of common long term conditions (particularly hypertension and COPD) may be under‐estimates; this may be indicative of unmet need; •
Unhealthy behaviours (e.g. smoking and drinking alcohol) are established in young people; 154 •
Teenage conception rates are comparatively low and have fallen by 44% since 1998; high rates are focused in areas of deprivation; •
Mental health and emotional problems are relatively common in young people. Life Expectancy Analysis of average life expectancy at birth from 2007‐09 reveals Solihull to be the only metropolitan district to be significantly better than the England average for males (80.0 years, 2.2% above 78.3) and one of only two for females (83.8, 1.8% above 82.3) – both are effectively top quartile for all districts in England. Further analysis of life expectancy at birth by deprivation quintile LSOAs from 2005‐09 shows Solihull to be above the England level for all quintiles, but that this positive gap diminishes with increasing deprivation (all data is available from the network of Public Health Observatories unless otherwise stated). As a result targeting the Solihull population in the bottom two quintiles would appear to be the local priority. Deprivation Quintile Top (First) Second Third Fourth Bottom (Fifth) Solihull 82.5
82.0
79.8
77.5
74.0
England 81.2
79.9
78.6
76.5
73.3
West Midlands 80.6 79.0 77.7 75.2 72.9 As the chart below shows the life expectancy gap between the bottom and top quintile in Solihull is the 5th highest in the West Midlands even though the borough’s life expectancy rank for the bottom quintile population is no worse than the 63rd percentile. By contrast, Cannock Chase, an authority with a similar bottom quintile rank (59th) has the 8th lowest life expectancy gap. 155 ween the top
p and bottom
m quintile poopulations in
n Solihull The exteent of the liffe expectanccy gap betw
can theerefore be attributed a
to
o the particcularly positive outcome
e among thhe most advvantaged populatiion group in
n the borou
ugh (ranked in the top 15% in the
e country). I n fact local gaps of inequality can be a misleading m
measure andd the local fo
ocus should be on increaasing life expectancy quintile population ratheer than narrrowing the gap between the bottom
m and top among tthe bottom q
quintile.. This is becaause the extent of the gaap in any givven geographical area caan be a conssequence of artifiicial political boundarie
es. For instaance, the Solihull boun
ndaries incluude sectionss of the populatiion socio‐economically and a historicaally linked to
o the Birmin
ngham metroopolitan are
ea (North Solihull) as well as population grroups linked to more affluent Warwicckshire. ality and M
Morbidityy Morta
Over thee last 10 yeaars, all cause
e mortality raates have fallen. Early de
eath rates frrom cancer a
and from heart disease and sttroke have ffallen and arre better thaan the England average. Priorities in
n Solihull alities, with a particular focus on re
educing deaath rates fro
om heart include reducing heealth inequa
disease, stroke and ccancer. owing chartss (2011 Heallth Profiles, DoH/NHS) show how ch
hanges in deeath rates for Solihull The follo
mid‐points of comparee with changges for the whole of Enngland. Notte that data points are m
o 3‐year averages of yearly rates. r
For exxample the ddot labelled 2003 represents the 3‐‐year period 2002 to t all ages and
d from all ca
auses, in thiss area with tthose for 2004. TTrend 1 compares rates of death, at England. Trend 2 compares rates r
of early death from
m heart dise
ease and stroke (in peopple under 75
5) in this area witth those for EEngland. 156 m cancer (in people unde
er 75) in thiss area with tthose for Trend 3 compares rates of earlyy death from
England. owing table iis a summaryy of the causses of death in Solihull co
ompared witth England: The follo
Excess w
winter death
hs 1 2
Infant deaths Smokingg related deaaths 3 Early deeaths: heart d
disease & stroke 4 Early deeaths: cancerr 4 SSolihull 16.1
4.81
182.8
61.6
101.7
England 18.1
4.71
216.0
70.5
112.1
1
Ratio off excess winteer deaths (obsserved winter deaths minuss expected deaths based onn non‐winter deaths) to averagge non‐winterr deaths (2006
6‐09) 2
Rate peer 1,000 live births (2007‐09
9) 3
Per 1000,000 populatiion aged 35 +,, directly age standardised rate (2007‐09
9) 4
Directlyy age standard
dised rate per 100,000 pop ulation underr 75 (2007‐09)) 157 It is notable that Solihull is significantly better than England in early deaths from heart disease & stroke and cancer as well as smoking related deaths. This suggests that mortality affecting the very youngest (infants) and the very oldest may be a more relevant focus for Solihull. The End of Life Care Profiles present data from 2008‐10 on the place and cause of death by age and sex. Solihull was found to have significantly higher proportions than England for the following main underlying causes; Males 0‐64:Cancer, Males 65‐84:Cancer, Females 85+:Cancer, Males 0‐
64:Cardiovascular (significantly lower only in Males 0‐64:Other Causes). Whilst this has no indication of outcomes in premature mortality it should inform the types care provided by the NHS, social services and the third sector, to adults approaching the end of life. This intelligence should also help drive improvements in the quality and productivity of services. Lifestyles There are considerable differences in attitudes and practices to healthy lifestyles across Solihull which are also strongly associated with outcomes in health. The chart below shows the number of Solihull Middle Layer Super Output Areas (MSOAs) in the bottom quartile for all MSOAs in England for binge drinking (16‐74 year olds for 2006‐08), healthy eating, obesity and smoking (all persons aged 16 and over, 2006‐08). Note that healthy eating and smoking both have the highest correlation (0.90) with all cause mortality (directly standardised rate for all persons under 75, 2005‐09). Count of MSOAs (total 29)
12
10
Bottom Quartile
Bottom Decile
8
Bottom 5th Percentile
6
4
2
0
Binge
Drinking
Healthy
Eating
Obesity
Smoking All Cause LE Female LE Male
Eight MSOAs (chart above) feature in the bottom decile nationally, comprising the six in the regeneration wards (Chelmsley Wood, Smith’s Wood and Kingshurst and Fordbridge), as well as the two in Castle Bromwich (obesity only). The chart below shows Solihull MSOAs in the best (top) quartile. There a couple of observations; firstly, the number of MSOAs in the top quartile suggests that affluence and positive health outcomes are a key feature of Solihull, and secondly, how binge drinking appears to be neither a specific problem nor a positive as shown for instance in smoking. This suggests that although there is not a severe problem with binge drinking in Solihull (the worst MSOA is only on the 22nd percentile) there are potential improvements across the borough and among all socio‐economic segments (Solihull has no MSOA in the top quartile). 158 18
Count of MSOAs (total 29)
16
14
12
Top Quartile
Top Decile
Top 5th Percentile
10
8
6
4
2
0
Binge
Drinking
Healthy
Eating
Obesity
Smoking All Cause LE Female LE Male
The following map reveals that the premature mortality is highest in the regeneration wards but that locally there is variation there and that there are pockets of potential health inequality in the Urban West of the borough (notably parts of Lyndon, Olton and Shirley West). 159 The final chart shows the gap between North Solihull and the rest of the borough in respect of depression prevalence and suggests that lifestyle choices are linked to personal and/or environmental factors. This is clearly a complex subject which requires further examination, but addressing local inequalities in lifestyle choices, mortality rates and life expectancy may require action on mental health and its underlying causes – both of these are covered in other sections of this assessment. 25%
Depression QOF Prevalence by Location
20%
North Solihull ‐ 17.4%
15%
10%
Rest ‐ 10.2%
5%
0%
The practical context of the above can be further understood as, environmental health, public protection and licensing officers within the authority would like to consider the efficacy of a strategy that could more effectively ameliorate problematic elements of the evening economy in particular (covering licensed premises, restaurants, takeaways and shopping), which would also deal with the adverse effects on the immediate neighbourhood such as noise and odour. It seems opportune to implement this strategy whilst bringing forward integrated policies on healthy eating and substance misuse. This could also be extended by co‐ordinating planning with public health in other areas such as tackling childhood obesity through addressing the saturation and location related to pupil commutation of hot food takeaways. Smoking Smoking is the biggest single preventable cause of disease and premature death in the UK. One in two regular smokers is killed by tobacco ‐ half dying before the age of 70, losing an average of 21 years of life. Preventing people from starting smoking is key to reducing the health harms and inequalities associated with tobacco use. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD, bronchitis and emphysema) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix. Stopping smoking is a public health priority. The risk of heart disease reduces to about half that of a continuing smoker within a year or so of stopping smoking, while the risk of lung cancer reduces to almost the same as the risk for people who have never smoked within 15‐20 years. Encouraging cessation among adults is also important in reducing smoking role models for children and young people. Neighbourhood Knowledge Management research in Doncaster shows that smoking 160 cessation success is 5.4 times less likely with children in the household, 3.2 times in social housing and 1.7 times more likely if a two adult household. Smoking attributable deaths in Solihull are significantly better than the England average. This is also found in deaths from lung cancer and chronic obstructive pulmonary disease (directly age standardised rates per 100,000 for 2007‐09 shown in the table below). The only indicator in the local tobacco control profiles found to be significantly worse than England is smoking in pregnancy (2009‐10), which is covered in detail under children’s health and well‐being. Smoking prevalence for those aged 18 or over (15.2%) is again significantly better than the England average (21.0%) for 2009‐10, which is also true of the key routine and manual worker subset (22.5% and 29.4% respectively). It should be noted that this key group is showing an improving trajectory compared with all adults which is deteriorating slightly (although still top quartile) – this suggests some potential efficacy in targeted interventions and that further research and monitoring is required for all other socio‐economic groups in Solihull. Smoking attributable deaths (aged 35 and above) Smoking attributable deaths from heart disease (35+) Smoking attributable deaths from stroke (35+) Deaths from lung cancer (all ages) Deaths from COPD (all ages) Solihull 182.8
27.6
7.1
33
20.7
West Midlands 216.7 32.8 10.8 37.6 26.7 England 216
32.1
10.1
38.2
26.2
People who were classified as ‘current smokers’ in 2008 smoked an average of 13 cigarettes a day. However, there are marked differences in sections of the community in smoking prevalence and consumption, varying by factors such as age, sex, social class and ethnicity. Data from the Integrated Household Survey 2009‐10 shows that smoking prevalence in England is 21.2% for adults aged 18 and over, this compares with a higher proportion of ex‐smokers (33.5%) and people that have never smoked (45.6%). At 29.4% smoking prevalence is highest in the routine and manual group (compared with 14% of adults in managerial and professional occupations), although, in common with the population as a whole, there are proportionally more ex‐smokers (30.8%) and people that have never smoked (39.8%) in this group. This balance has been steadily shifting towards ex‐smokers since 2005, when there were equal proportions (24%) of smokers and ex‐smokers. Nevertheless, it should be noted that people in deprived circumstances are not only more likely to take up smoking but generally start younger, smoke more heavily and are less likely to quit smoking , each of which increases the risk of smoking‐related disease. Smoking prevalence amongst adults is highest for those aged 20‐24, and gradually declines with age, through quitting or dying. In England, almost a third (32%) of people aged 20‐24 were smokers in 2008. The lowest level of smoking (12%) was amongst people aged 60 and over. Taking up smoking at an early age greatly increases the health risks of smoking, such as the risk of developing lung cancer. Children and young people who start smoking are more likely to continue smoking as adults, and are less likely to give up than those who start smoking in later life. Almost two thirds (66%) of adult smokers in England in 2008 started before they were 18 years old. Only 5% of smokers started at the age of 25 or over. There is also a gender bias, In England in 2009, an estimated 23% of all deaths among men aged 35 and over were attributed to smoking, compared with 14% of all deaths among women. Breathing other people's smoke causes both short and long term health problems. Immediate effects include eye irritation, cough, dizziness and nausea. Longer term exposure raises the risk of 161 death from lung cancer and from coronary heart disease. For people who already have asthma or coronary heart disease, other people's smoke can precipitate severe symptoms. A child exposed to secondhand smoke has an increased risk of sudden infant death (‘cot death’), asthma, wheeze, lower respiratory infection, middle ear disease and meningitis. Among non‐smoking children aged 4‐
15 in England in 2006‐2008, three in five had recently been exposed to secondhand smoke. Children from lower income households were more likely to have been exposed to secondhand smoke than those from higher income households. However, it is important to recognise that smoking levels have fallen markedly in recent decades. In 1980, 39% of adults in England smoked, compared to 28% in 1998 and 21% in 2008. The proportion of adults who never or only occasionally smoked has increased from 43% in 1982 to 53% in 2008. Physical Activity The Health and Social Care Information Centre report “Statistics on obesity, physical activity and diet: England, 2011” reveals: In 2009‐10, almost a quarter of adults (24.3% of respondents) in England reported that they had taken part in sport on 11 to 28 days within a four week period. In 2009, 41% of respondents said they made walks of 20 minutes or more at least 3 times a week and an additional 22% said they did so at least once or twice a week. However 20% of respondents reported that they took walks of at least 20 minutes “less than once a year or never”. Average total sedentary time combines both time spent watching the television and other sedentary time. Similar proportions of men and women were sedentary for six or more hours on weekdays (32% and 33% respectively). However, on weekend days, men were more likely to be sedentary for six or more hours than women (44% of men and 39% of women). In 2009‐10, 86% of 5‐10 year olds had taken part in sports activities outside of school time in the last four weeks and of these, almost 78% participated in the last week. Whereas 97% of 11‐15 year olds have taken part in sporting activities in the last four weeks and of these, 88% had participated in the past week. The Local Health Profile for Solihull shows the proportion of physically active adults (aged 16 or over) in 2009‐10 to be 10.3% compared with 11.5% for England. However, the 5th wave (year to October) of the Sport England Active People Survey appears to suggest that in terms of moderate intensity sport (at least 12 sessions of at least moderate intensity for at least 30 minutes in the previous 28 days), Solihull compares favourably with the national average (proportion of population aged 16 or over in the chart below): 162 19%
%
18%
%
17.5%
17..4%
16%
%
16.5%
16.3%
15%
%
15.5%
14.9%
17%
%
14%
%
14.7%
13%
%
SSolihull
E
England
W
West Midlands
s
12.1%
12%
%
11%
%
10%
%
2007‐0
08
200
08‐09
2009‐10
2010‐11
owing chart illustrates fiindings from
m the 2010 H
Health Relate
ed Behaviouur Questionnaire that The follo
reveals tthe proportiion of pupilss (resident inn Solihull) taaking part in physical acttivity for five
e days or more peer week, sho
owing; falls for both geenders as they progress in secondarry education
n, and an inherentt gap betweeen genderss that mightt widen with
h age – fem
males in Norrth Solihull are a most affected
d by this redu
uction. Excesss Alcohol Governm
ment recommendations at the timee of publication are that adult men should not regularly drink mo
ore than 3‐4
4 units of alco
ohol a day a nd adult women should not regularlly drink more
e than 2‐
3 units a day. Although the further advicee also recom
mmends two alcohol freee days per week. w
In Solihull there are esstimated to be 6,341 peeople classed
d as ‘higher risk drinkerss’, these are drinkers who havve a high riskk of having an alcohol rellated illness.
163 The Health and Social Care Information Centre report “Statistics on Alcohol: England, 2011” reveals: 69% of men and 55% of women (aged 16 and over) reported drinking an alcoholic drink on at least one day in the previous week. 10% of men and 6% of women reported drinking on every day in the previous week. 37% of men drank over 4 units on at least one day in the week prior to interview and 29% of women drank more than 3 units on at least one day in the week prior to interview. 20% of men reported drinking over 8 units and 13% of women reported drinking over 6 units on at least one day in the week prior to interview. The average weekly alcohol consumption was 16.4 units for men and 8.0 units for women. 26% of men reported drinking more than 21 units in an average week. For women, 18% reported drinking more than 14 units in an average week. Hazardous drinking is defined as a pattern of drinking which brings about the risk of physical or psychological harm. Harmful drinking, a subset of hazardous drinking, is defined as a pattern of drinking which is likely to cause physical or psychological harm. In 2007, 33% of men and 16% of women (24% of adults) were classified as hazardous drinkers. This includes 6% of men and 2% of women estimated to be harmful drinkers, the most serious form of hazardous drinking, which means that damage to health is likely. Among adults aged 16 to 74, 9% of men and 4% of women showed some signs of alcohol dependence. The prevalence of alcohol dependence was slightly lower for men than it was in 2000 when 11.5% of men showed some signs of dependence. There was no significant change for women between 2000 and 2007. In 2009/10, there were 1,057,000 alcohol related admissions to hospital. This is an increase of 12% on the 2008/09 figure (945,500) and more than twice as many as in 2002/03 (510,800). In 2009/10, 63% of alcohol related admissions were for men. Among both men and women there were more admissions in the older age groups than in the younger age groups. In 2009, there were 6,584 deaths directly related to alcohol. This is a 3% decrease on the 2008 figure (6,769) but an increase of 20% on the 2001 figure (5,477). Of these alcohol related deaths, the majority (4,154) died from alcoholic liver disease. Fewer people per 100,000 population aged below 75 are dying from respiratory disease compared to nearly a decade ago. However the opposite is true for liver disease; with a greater number of deaths per 100,000 of the population from this condition in 2009 compared to in 2001. About 20 women and 29 men per 100,000 of the population died from respiratory disease; compared to about 22 and 33 per 100,000 respectively in 2001. About 10 women and 19 men per 100,000 of the population died from liver disease; compared to about 9 women and 16 men in 2001. In a similar vein to smoking many indicators in the alcohol profile of Solihull are significantly better when compared with the England average. These include alcohol specific mortality ‐ males, mortality from chronic liver disease – males, alcohol‐attributable hospital admission – both males and females. Indeed the only indicator that is significantly worse than England is the proportion of all employees working in bars but it could be argued that this is symptomatic of the leisure hubs found throughout Solihull and should not necessarily be construed automatically as a negative. The following table highlights a difference between relative outcomes for males and females in Solihull when compared with all other authorities (although it should be noted that actual outcomes in all instances are worse for males than for females). 164 or Indicato
Higher R
Risk drinkingg (% of drinkers only) synnthetic estim
mate (2008)
Alcohol‐‐attributable
e mortality ‐ males (20099) Lower R
Risk drinking (% of drinke
ers only) synnthetic estim
mate (2008)
Alcohol‐‐specific mortality ‐ male
es (2007‐09)) Increasing Risk drinkking (% of drrinkers only)) synthetic e
estimate (2008) Mortalitty from chro
onic liver dise
ease ‐ maless (2007‐09) Binge drrinking (syntthetic estima
ate ‐ 2008) Admission episodess for alcohol‐‐attributablee conditions (2009‐10) Mortalitty from chro
onic liver dise
ease ‐ femal es (2007‐09)) Alcohol‐‐attributable
e hospital ad
dmission ‐ feemales (2009
9‐10) Alcohol‐‐attributable
e hospital ad
dmission ‐ m
males (2009‐1
10) Alcohol‐‐specific hosspital admisssion ‐ femalees (2009‐10)
Alcohol‐‐specific mortality ‐ females (2007‐009) Alcohol‐‐specific hosspital admisssion ‐ males (2009‐10) Alcohol‐‐specific hosspital admisssion ‐ under 18s (2007‐09) Alcohol‐‐attributable
e mortality ‐ females (20009) Employeees in bars ‐ % of all emp
ployees (Annnual Businesss Inquiry, 2009) Percenttile 16.6 19.3 20.9 27.3 28.5 29.4 31.6 37.4 445.1 446.3 446.6 52.8 58.3 62.3 63.5 64.7 777.6 Qu
uartile Top T
2nd 3rd Bo
ottom Subsequ
uent analysis of gender differencees reveals an a increase in hospital alcohol‐attrributable admissio
on (may be attributed to the conssumption off alcohol) fo
or both malles and fem
males but contrastting trajectorries for alcoh
hol‐attributaable mortalityy (falling for males, risingg for femaless). This is particulaarly significant in that So
olihull is now
w ranked on tthe 65th perccentile for alll Local Authorities in n
England for female aalcohol attrib
butable morttality (the 2nd
worst alcohol indicatorr in the borough). 165 People with a ‘hazardous alcohol problem’ People hospitalised due to alcohol consumption on an annual basis Annual rise in hospital admissions Nationally 12 million Solihull 33,000 800,000 3,534 10% 21% Comments From a population of 220,000 Should be 2,200 if extrapolated Solihull 62% in 3 years Alcohol specific conditions are those that are wholly related to alcohol (e.g. alcoholic liver disease or alcohol overdose). It is important to note that alcohol consumption can have a significant impact on mental health with suicide eight times more likely to occur in the presence of alcohol misuse or dependency. Furthermore, at least two thirds of people entering treatment for alcohol dependency have depressive symptoms or similar; and personality disorder and schizophrenia may give people a pre‐disposition to alcohol dependency. During the period April 2008–September 2011, there were 1,732 patients admitted to hospital, which resulted in 3,472 individual alcohol specific admissions in Solihull. From these 1,732 patients, there were 5,299 attendances into Accident and Emergency (A&E). The client’s journey is tracked primarily in Hospital to see if they have been admitted, and then to see if they have had an attendance into A&E. The age breakdown can be shown as follows (local Hospital Episode Statistics data): Age band <16 16‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75+ Male Rate per 100,000 8.7 307.9 704.7 743.6 989.2 811.6 803.3 619.5 Female Rate per 100,000 19.6 261.1 348.3 378.1 564.4 302.1 194.9 141.5 Based on the age breakdown for the above admissions, it is clear the main age range was the 45–54 age group. This age range may be those middle aged individuals who have used alcohol for a number of years and now signs are showing of the effects of years of misuse. When looking at specific admissions over the 4 year period for the 45‐54 age group the percentage of admissions are highest in Chelmsley Wood 14.7% and Lyndon 10.1%, not a dissimilar pattern to the overall location of all admissions shown below. It should also be noted that those area that contain a higher proportion of chronic dependent drinkers are also likely to see increases in the prevalence of Korsakoff's dementia. 166 Alcohol consumption by under 1
18s remains a significantt problem across the UK.. Whilst the rresponse to youngg people's d
drinking has often focuseed on the pu
ublic nuisancce and anti‐ssocial consequences, there is increasing eevidence of tthe serious hheath and w
well‐being pro
oblems that young drinkkers face, as well as concerns about the dangers of ddrinking in risky, r
unsupe
ervised envi ronments. Solihull's rate of aalcohol specific hospital admissions ffor young pe
eople (North West Publicc Health Obsservatory Local Alcohol Profilee England, 2010) 2
is signnificantly worse than the
e national annd regional average. Solihull is ranked 262nd out of 354 Local Autthority areass. Informal research un
ndertaken w
with young peeople’s serviices indicate that the moost common ways for young people to obttain alcohol w
were for parrents to provvide it or for an older perrson to purch
hase it. It could bee assumed that t
the pro
ovision of allcohol by paarents implie
es consent w
which is in line with nationall research which conclud
des that ‘thee average parent is happ
py for their cchild to start drinking at homee at the age o
of 13’. This age correspoonds to a key developme
ent stage of the part of tthe brain associatted with reeward and positive feeelings. Research indicating evenn moderate alcohol al Officer consumption at thiss age can be damaging ccontributed tto advice issued by the CChief Medica
in 2009 that young people unde
er the age oof 15 should not consum
me alcohol att all. There are clear links b
between the misuse of alcoho l and oth
her health concerns e.g. tobaccco use, unplann
ned/unproteccted sexual activity, eatting disorde
ers, poor me
ental and em
motional we
ell‐being. Research also inform
ms us that there is evideence of othe
er poor outccomes such aas lower edu
ucational ment, deprivvation, harmful relations hips and antti‐social/crim
minal behavioour. achievem
167 It should also be noted that alcohol misuse will impact on families and may have potential domestic abuse and /or safeguarding implications. Families need to play their role in supporting the clients through treatment and on to recovery. This area is one which needs developing further, as the Alcohol service becomes more established and developed. Significant progress has been made in this area for drug misuse, and family and friends programmes, user groups, and family support groups specific to Alcohol misuse would not only benefit the individual, but also provide the service areas to gain a better understanding of the size and nature of the problem in Solihull. It should also be noted that, according to the British Crime Survey, there were 170 serious sexual assaults in Solihull during the 2009‐10 year of which 130 were rapes on females. Analysis across the West Midlands Police Area by NHS Birmingham East and North suggests that there is a considerably heightened risk of incidents in more popular ‘central’ areas. It is expected that with the integration of Public Health within local authorities that opportunities for multi‐disciplinary initiatives will increase. The Food and Safety Team within Public Protection at Solihull MBC carried out a survey in 2011 of licensed premises and found a level of 16% non compliance with regard to spirits sales such as counterfeiting and avoidance of duty. This has clear health impacts whereby a concerted approach from all partners could further help to mitigate the most harmful effects that consumers might face (counterfeit alcohol [vodka] containing methanol when denatured with ethanol can be fatal and can cause blindness ‐ is also difficult to differentiate with alcohol). Substance Misuse There are approximately 550 adults in drug treatment programmes within Solihull of which the majority (56%) are resident in the wards of North Solihull (including Castle Bromwich). Roughly 4 in 5 clients are receiving treatment for heroin addiction with 57% being from North Solihull. However, the majority (61%) of those receiving treatment for cocaine live in the south of the borough, this is because use of cocaine is often associated with the night‐time economy (of most significance in Solihull Town Centre) and is often linked to more “affluent” drug takers. One of the main benefits of drug treatment to society, is reducing crime. Recent research from the National Treatment Agency (NTA) showed that the total number of crimes committed by users almost halved following the start of treatment. Nationally, a quarter of those coming into treatment now are referred from the criminal justice system. This proportion is one which is mirrored locally, where a similar proportion of our clients in Solihull are referred to treatment services via the criminal justice route. If you are arrested for a 'trigger offence', you may be tested to find out if you have taken any Class A drugs. Trigger offences include: theft, robbery, burglary, motor vehicle‐theft, handling stolen goods, possession of an illegal drug and possession of an illegal drug with intent to supply. During the period 1 October 2010 – 30 September 2011, a total of 1367 drug tests were conducted, 555 of these were positive (40.6%). The main crime involved for the tests conducted was ‘theft’ (52%). The recently updated Glasgow estimate for the number of opiate and/or crack users (OCUs) in the borough, for those aged 15 – 64 is 1,008. This estimate has fallen slightly compared to last year, but has remained around 1,000 for a number of years now. The estimated number of opiate users in the borough is 759 and crack users is 569. It does seem clear that this group is getting older and that fewer young people are taking up these particularly damaging habits. 168 Most young people do not use illegal drugs. Of those that do, only a very small proportion use drugs such as cocaine or heroin or have developed drug dependency/addiction. According to the HRBQ survey, just 3.5% of Year 10 respondents had ever tried a Class A drug. Despite this, drug use can still have a profound impact on a young person's physical health, emotional well‐being, relationships, educational achievement and life chances. Cannabis and Alcohol use continue to be the main substances used amongst Young People, not only in Solihull, but nationally. In the new drug strategy, the Government has set out a clear ambition for individuals to achieve recovery and support people to live a drug free life. Recovery involves three overarching principles, well‐being, citizenship, and freedom from dependence. We know that there are a wide range of changes that people may make in the course of a recovery journey, and, therefore, recovery may be best defined by the outcomes that are achieved in the course of an individual’s journey. A number of best practice outcomes have been identified in the new strategy, these include: 







Freedom from dependence on drugs or alcohol Prevention of drug related deaths and blood borne viruses Reduction in crime and re‐offending Sustained employment Ability to access and sustain suitable accommodation Improvement in mental and physical health and well‐being Improved relationships with family members, partners and friends The capacity to be a caring and effective parent Sexual Health Teenage pregnancy is a significant public health issue in England. Teenage parents are prone to poor antenatal health, lower birth weight babies and higher infant mortality rates. Their health, and that of their children, is worse than average. Teenage mothers are less likely to finish their education, less likely to find a good job, and more likely to end up both as single parents and bringing up their children in poverty. The children themselves run a much greater risk of poor health, and have a much higher chance of becoming teenage mothers themselves. The rate of teenage conceptions (live births and terminations combined) in Solihull in 2010 was 22.5 per 1,000 females aged 15‐17. This is significantly better than the England level of 35.4, and represents a decrease in Solihull of 44.2% from the 1998 baseline. Furthermore, the under 16 rate (per 1,000 females aged 13‐15) at 6.3 is also significantly better than England (7.9). Whilst conception rates have decreased the proportion of teenage conceptions in 2010 that led to a termination was 55.9%, which is considerably higher than the England value of 50.3%. This could in some ways reflect the relative affluence of Solihull, but also suggests that there is a degree of unwanted pregnancy that could be attributed to the need for further improvements in sexual health and reducing associated risk taking behaviours ‐ the proportion of those aged 10‐15 engaging in frequent substance misuse (2008) at 14.9% is significantly higher than England (10.9%). The number of under 19 repeat abortions in 2010 encouragingly is undisclosed, as being below 10. Recent initiatives including active post termination contraception access have contributed to this 169 achievement. However, this should be considered alongside the proportion of repeat abortions for those aged under 25 at 30.6% being significantly higher compared with 25.1% for England. Although the GP prescribed Long Acting Reversible Contraception (LARC) per 1,000 females aged 15‐
44 (2009‐10) cannot be linked with abortions the rate of 41.8 in Solihull is significantly below England (46.9). The rates of the following sexually transmitted diseases and HIV are all lower in Solihull than England: Proportion of 15‐24 year olds testing positive for Chlamydia outside GUM clinic (2009‐10) “ ” Rate per 100,000 aged 15‐24 in all settings (2009) Under 30 rate of Pelvic Inflammatory Disease admissions per 100,000 aged 15‐29 (2009‐10) Gonorrhoea diagnoses in GUM clinics per 100,000 population (2009) Syphilis diagnoses in GUM clinics per 100,000 population (2009) Prevalence of diagnosed HIV per 1,000 population aged 15‐59 (2009) Solihull Care Trust 4.8
England 6.0 1,633.1
2,212.8 74.3
87.4 17.0
29.7 <3.0
5.5 0.58
1.81 Availability of Affordable Healthy Food Good nutrition is vital to good health. Whilst many people in England eat well, a large number do not, particularly among the more disadvantaged and vulnerable in society. In particular, a significant proportion of the population consumes more than the recommended amount of fat, saturated fat, salt and sugar. Such poor nutrition is a major cause of ill health and premature death in England. Cancer and cardiovascular disease, including heart disease and stroke, are the major causes of death in England, accounting together for almost 60% of premature deaths. About one third of cancers can be attributed to poor diet and nutrition. The Department of Health has estimated that if diets matched nutritional guidelines, around 70 000 deaths in the UK could be prevented each year and that the health benefits (in terms of quality adjusted life years (QALYs)) would be as high as £20 billion each year. Increasing the consumption of fruit and vegetables can significantly reduce the risk of many chronic diseases. It is estimated that eating at least 5 varied portions of fruit and vegetables a day can reduce the risk of deaths from chronic disease, stroke, and cancer by up to 20%. Research has shown that each increase of one portion of fruit or vegetables a day lowers the risk of coronary heart disease by 4% and the risk of stroke by 6% (Joshipura et al, 2001). Evidence also suggests that an increase in fruit and vegetable intake can help lower blood pressure. Unhealthy diets, along with physical inactivity, have contributed to the growth of obesity in England. The proportion of men classed as obese increased from 13.2% in 1993 to 23.7% in 2006 and from 16.4% to 24.2% for women during the same period. Obesity is a growing problem among children 170 and young people too. Around 16% of 2 to 15 year olds are obese. Worldwide, approximately 58% of type‐two diabetes, 21% of heart disease and between 8‐42% of certain cancers is linked to an excess of body fat. Relative risk of death is also increased in those whose BMI is above the normal range. The Health and Social Care Information Centre report “Statistics on obesity, physical activity and diet: England, 2011” also reveals: In 2008‐09, it was found that people are eating less saturated fat, trans‐fat and added sugar than they were 10 years ago. In 2009, around 1 in 5 children aged 5 to 15 consumed five or more portions of fruit and vegetables a day (21% of boys and 22% of girls). This has increased from 5 years ago where the corresponding figures were 13% and 12% in 2004. In 2009, in the UK, there was a reduction in the quantities purchased in most major food groups. For example, purchases of fresh fruit fell by 3.6% between 2008 and 2009 and fresh green vegetables fell by 1.1%. It would be interesting to determine any impact since the recession on food purchase habits. Total energy intake per person has risen since 2008 values but the overall trend from 2006 is downwards. Total energy intake for 2009 was 2303 kcal per person per day (2,276 in 2008). However, despite this suggested progress, the British Heart Foundation assert (in their 21st Century Gingerbread House report): “We know that on average children’s diets contain too much salt, fat and sugar, and this could have serious implications for future levels of heart disease. But how can we realistically expect children’s diets to improve while they are surrounded by conflicting messages about health and food? At school, children are taught the importance of healthy eating. Yet in their online space they are bombarded by promotions for foods and drinks high in fat, sugar, and salt. Children are being targeted for their own spending power, and because of their ability to influence their parent’s spending. Claims that marketing does not increase children’s consumption of unhealthy foods used to be commonplace. But research has now shown that the marketing of unhealthy foods to children influences not only which brands they choose, but the overall balance of their diet. Unsurprisingly, it encourages children to eat energy‐dense fatty, sugary or salty foods rather than more nutritious options. If marketing didn’t work, the food industry wouldn’t devote multi‐million pound budgets to developing slick campaigns to spread their messages.” Food poverty has been defined as the inability to obtain a nutritionally adequate diet, and refers to households that “do not have enough food to meet the energy and nutrient needs of all of their members”. A number of factors can lead to the development of food poverty in a household including: inability to access food outlets in a local area; poor availability of healthy food items even if there is access to food outlets in a local area; certain population groups may experience problems related to affordability of healthy items to achieve a healthy diet; and a lack of awareness of what constitutes a healthy diet may also play an important role. A number of different population groups have been identified as being most likely to live in food poverty. The elderly or individuals with restricted mobility may have problems in accessing healthy food if there is not adequate availability in their local area. Due to mobility problems, these groups will be unable to travel long distances to supermarkets outside their local area, especially if there is not adequate public or community transport in place. Households with dependent children and 171 members of black and minority ethnic groups are also reported as being at risk of living in food poverty. Low income groups and those that are unemployed or living on benefits are also reported as being at risk of food poverty, due to the limited budgets of these population groups. For the majority of these groups, the proportion of their budget that is spent on food is flexible and is often the amount that remains after all other bills have been paid. At specific times of the year, eg during the winter, the proportion available for food may be significantly reduced. Such limitations may prevent these groups from purchasing an adequate amount of food to achieve a healthy diet. Interestingly, given the borough’s relative affluence, the estimated proportion of adults (aged 16 or above, 2006‐08) eating healthily in Solihull is only in‐line with the England average (28.5% compared with 28.7%). As well as overall diet it is important to understand the links between food hygiene and health. In the Food Standards Agency 2011 Chief Scientist Annual Report it was Estimated that each year in the UK approximately one million people suffer from food‐borne illness of which, 20,000 people receive hospital treatment and 500 die. The estimated cost of this per year is £1.5 billion. In Solihull there are 1,697 known food businesses which are subject to inspection according to their risk ratings determined by the Food Law Code of Practice (to ensure compliance with food safety and food standards legislation). This can range from an inspection every six months to an inspection every two years dependent on risk. Lower risk premises receive an intervention from the team every three years. In 2010/2011 initial 651 food hygiene inspections were carried out, some of these premises would have received further visits by officers until acceptable standards of hygiene were achieved. It is worth noting that there are seven approved premises within Solihull, which are for those premises which for a variety of reasons would pose a higher risk to public health should a problem occur e.g. due to their size, the extent of the business or the nature or complexity of the food business operation – these include dairy production, cheese and baby food manufacture, manufacture of meat products and catering for airlines, hospitals and children’s nurseries. Of more direct relevance, perhaps, for residents and visitors to Solihull, Public Protection carry out inspections, investigations and regularly participate in sampling programmes for food labelling and composition which aim to determine levels of compliance with food standards legislation. Through sampling the following was also found: a survey of food contact materials found migrating plasticisers (probable carcinogens) in some cooking utensils that subsequently generated a national withdrawal of affected cooking equipment and subsequent tighter legislative standards; a survey of lightly cooked foods from local premises found unacceptable microbiological levels in some samples ‐ followed up with advice to premises on hygiene and safe food preparation; a survey of cleaning cloths and hygiene standards found microbiological failures in some retail and catering premises ‐ followed up with advice to these premises to improve standards. The Food Standards Agency also convey emerging risks with ochratoxins in fruit and vegetables (risk from inadequate storage) and acrylamide in fried foods (not expected from typical exposures in foods) in particular that may be of relevance for Solihull. Through food standards inspections the Food Team in Public Protection advise caterers in a wide variety of settings from nursing homes and nurseries, to fish and chip shops and takeaways about healthier food choices, passing on information about reducing salt, sugar and fat in recipes and 172 discussing the possibilities of providing customers with healthier food choices. Current investigation is being carried out to determine the potential to encourage caterers to provide healthier food choices by the introduction of an award scheme similar to Solihull’s Scores on the Doors. Scores on the Doors is a scheme currently operated to encourage improved standards of hygiene and provides consumers with information regarding the food hygiene standards of food businesses (500‐600 caterers handling and preparing high‐risk foods for the public). This allows consumers to make an informed choice about where they eat (it is notable that the regeneration area has a premises profile of 10.5% zero to one star rated premises versus an authority average of 6.3%). Previously, additional funding has enabled work to be done with teenagers to help them make healthier choices, through make and taste sessions and quizzes on understanding food labels. It has been recognised that there is potential to strengthen public health impact by rewarding food businesses that provide healthier food options. New regulations came in to force on the 1st January 2010 requiring Local Authorities to; conduct risk assessments, investigations and examine and analyse water samples in relation to private water supplies. Private water supplies come from ground waters, deep wells, springs or bore holes and can be contaminated with chemicals or micro‐organisms depending on the quality of the supply and any water treatment facilities. The risk assessment and analysis seeks to establish that the water quality is wholesome ie that it is fit to drink. Officers have the power to require remedial action to ensure that water meets the required standard. The Local Authority has a duty to carry out a risk assessment of large supplies within 5 years (by December 2014) and every five years thereafter. Monitoring of these supplies will take place on an annual basis through sampling. At the end of January 2011 Solihull had 15 single dwellings with private water supplies, 3 large supplies with private water supplies (‘commercial activity’) and 5 premises classed as having private distribution systems. Obesity The report “Statistics on obesity, physical activity and diet: England, 2011” also reveals: In 2009, almost a quarter of adults (22% of men and 24% of women aged 16 or over) in England were classified as obese (BMI 30kg/m2 or over). A greater proportion of men than women (44% compared with 33%) in England were classified as overweight in 2009 (BMI 25 to less than 30kg/m2). Thirty‐eight per cent of adults had a raised waist circumference in 2009 compared to 23% in 1993. Women were more likely than men (44% and 32% respectively) to have a raised waist circumference (over 88cm for women and over 102 cm for men). Using both BMI and waist circumference to assess risk of health problems, for men: 19% were estimated to be at increased risk; 14% at high risk and 20% at very high risk in 2009. Equivalent figures for women were: 14% at increased risk, 18% at high risk and 23% at very high risk. In 2009, around three in ten boys and girls aged 2 to 15 were classed as either overweight or obese (31% and 28% respectively), which is very similar to the 2008 findings (31% for boys and 29% for girls). In 2009, 16% of boys aged 2 to 15, and 15% of girls were classed as obese, an increase from 11% and 12% respectively in 1995. Whilst there have been marked increases in the prevalence of obesity since 1995, the prevalence of overweight children aged 2 to 15 has remained largely unchanged (values were 15% in boys and 13% in girls in 2009). In 2009‐10, around one in ten pupils in Reception class (aged 4‐5 years) were classified as obese (9.8%). This compares to around a fifth of pupils in Year 6 173 (aged 10‐11 years) (18.7%). Boys were more likely to be obese than girls for both groups. In 2009‐10, 13.3% of pupils in Reception class and 14.6% of pupils in Year 6 were reported as being overweight. The health outcomes from the above research have found: In 2008, among adults aged 16 and over, overweight or obese men and women were more likely to have high blood pressure than those in the normal weight group; high blood pressure was recorded in 48% of men and 46% of women in the obese group, compared with 32% of overweight men and women and 17% of men and women in the normal weight group. The number of recorded Finished Admission Episodes (FAEs) in NHS hospitals with a primary diagnosis of obesity among people of all ages was 10,571 in 2009‐10. This is over ten times as high as the number in 1999‐2000 (979) and more than 30% higher than in 2008‐09 (7,988). In 2009‐10, the number of recorded Finished Consultant Episodes (FCEs) with a primary diagnosis of obesity and a main or secondary procedure of ‘bariatric surgery’ among people of all ages was 7,214. Females continue to account for the majority of these; in 2009‐10 there were 1,450 such FCEs for males and 5,762 for females. Hospital coding for bariatric surgery was updated in 2009‐10, which means it is now possible to identify how many bariatric procedures were for maintenance of an existing gastric band; 1,444 were for maintenance. In 2009, the number of prescription items dispensed for the treatment of obesity was 1.45 million; this is more than eleven times the number in 1999 (127 thousand). In 2009‐10, the age groups with the highest number of admissions with a primary diagnosis of obesity were those aged 35 to 44 (3,132) and those aged 45 to 54 (3,076). Together these two age groups accounted for more than half of all such admissions. The 2010‐11 GP Quality Outcome Framework (QOF) prevalence data for all practices within the Solihull Care Trust reveals a significant gap between those practices found in North Solihull and the rest but also that 5 of the 7 highest ranked for obesity are found in North Solihull. The chart below highlights this notable difference. 20%
Obesity QOF Prevalence by Location
18%
16%
14%
North Solihull ‐ 13.7%
12%
10%
Rest ‐ 8.7%
8%
6%
4%
2%
0%
The Department of Health commissioned work examining attitudes and behaviours of families relating to diet and activity which subsequently developed into a segmentation model. The following map highlights the Living Healthily cluster group calculated by the West Midlands Public 174 Observatory (WMPHO) at output areea level. Thiss shows that in largely afffluent, built‐‐up areas Health O
of the bo
orough a significant prop
portion of thhe population
n belong to tthe Living Heealthily group
p (darker green and blue), bu
ut suggests that t
in otheer parts of Solihull S
a ma
ajority of thee population
n do not ow). This ssuggests thaat attitudes to diet andd activity in sparsely qualify (lighter greeen and yello
h, such as p arts of Blyth
he and Meriden, are rel atively unfavourable populateed areas of the borough
(plenty o
of exercise b
but potentially too manyy bad foods)), as well as in deprived areas, such as North Solihull (young pareents who lacck knowledgge and paren
nting skills to implemennt a healthy lifestyle) and in m
moderately affluent are
eas such as parts of Shirley, Lyndon
n, Elmdon aand Castle Bromwich (strong ffamily valuess and parentting skills butt need to maake changes to their diet and activity levels). Oral H
Health The term
m oral healtth refers to the health of people’s teeth, gumss and suppoorting bone and soft tissues ((including th
he tongue, lips and mou th). Oral he
ealth is an im
mportant paart of genera
al health. Good orral health en
nables individ
duals to com
mmunicate w
well, eat a va
ariety of fooods, and is im
mportant for self esteem and
d social con
nfidence. Pooor oral heaalth can reduce a persoon’s ability to eat a us diet, affecct self image and confideence and cause significant pain. nutritiou
Over thee last 30 yeaars there havve been greaat improvements in oral health in Enggland. Howe
ever, oral diseasess are still veery common. The most common orral diseases are dental ccaries (tooth
h decay), periodontal disease (gum diseasse) and oral ccancer. Thesse diseases a
are largely prreventable and share n risk factorss with other general diseeases for example smokking and highh sugar diet. Certain common
groups are particularly suscep
ptible to oraal disease. These inclu
ude those w
who are vulnerable, 175 disadvantaged and socially excluded. Dental health in children is also an important predictor of future health, as a causative factor of decay is what we eat or drink. There is some data available from national children’s surveys which indicate that there may be an issue in Solihull with dental health for children as they get older (although it should be noted that these surveys have limited currency due to timeliness, sampling and self selection). The following chart reveals that the proportion of children with either decayed, missing (due to decay) or filled teeth appears to rise considerably in Solihull where for 5 year olds the proportion is below both the England and West Midlands average, yet for 12 year olds the proportion is above both comparisons. 40
35.1
35
% DMFT >0
30
32.0
28.9
26.7
33.4
30.9
25
20
15
10
5
0
Solihull
West Midlands
5 year old survey (2007‐08)
England
12 year old survey (2008‐09)
Disease Groups Cancers Around one person in three in the UK will develop a cancer at sometime in their life. One in four will also die from cancer, making it the second most common cause of death after circulatory disease. Cancer survival rates are increasing, however, with half of people diagnosed with cancer now surviving for five years. The most common cancers are of the breast, lung, bowel and prostate, together accounting for over half of all new cancers each year. Lung cancer is the most common cause of cancer death in both men and women, leading to around one quarter of all deaths from cancer in men and one fifth in women. A 2011 report from Cancer Research UK suggests that 85.6% of lung cancer can be attributed to smoking, as well as 65.5% for oesophagus (gullet) and 21.1% for bowel cancers. Cancer of the oesophagus is also significant for proposed factors; lack of fruit and vegetables (46.1%), obesity (21.7%) and alcohol (20.6%). Although cancer can develop at any age it is most common in older people. Around three‐quarters of cases occur in people aged 60 and over, whilst three‐quarters of deaths from cancer are in people aged 65 and over. However, lifestyle, socio‐economic factors, ethnicity and genetic predisposition also have an influence on cancer risk, with smoking being the single biggest cause of cancer. The relationship between deprivation and lung cancer incidence and mortality has been shown to be particularly strong, with incidence rates being two and a half times higher and mortality rates twice as high in the most deprived areas as the least. 176 The incidence of cancers for the Solihull Care Trust (2006‐08 age standardised all persons per 100,000) at 405.8 is marginally higher than the UK at 395.5. However, mortality (2007‐09) is slightly lower with 163.3 compared with 178.0. This also masks considerable differences by gender: Incidence (2006‐08) Solihull Care UK Trust 359.9 367.6
* 451.6 423.5
Female Male * Solihull significantly worse than UK Mortality (2007‐09) Solihull Care UK Trust 134.3
149.9
192.3
206.1
Prostate cancer perhaps explains the variance in the table above, with a Solihull rate of 137.5 compared with 100.5 for the UK. However, the mortality rate is again slightly better with 22.4 compared with 24.0. This is also reflected in survival rates being comparatively better, particularly at five years: Survival (%) 1 year (2004‐2008) 3 year (2002‐2006) 5 year (2000‐2004) Solihull Care Trust 98.5 94.8 94.0 UK 95.0
87.8
82.2
Another significant variance between Solihull and the UK is malignant melanoma for females (23.0 compared with 16.2). The rate is subsequently higher also for all persons (20.3 and 15.7 respectively) but is also higher for males (17.6 and 15.2). Mortality for males is in‐line with the UK (3.2 and 3.1) but females is clearly higher (3.4 and 2.1). The index of cancer survival [ONS] for Solihull Care Trust (% of all cancer cases combined) has narrowed markedly from 1996 to 2009 when compared with England for those aged between 55 and 64 years, with the gap falling from 3.2 percentage points in 1996 (Solihull 69.8%, England 66.6%) to just 0.2 in 2009 (74.6% and 74.4% respectively). 177 One‐Year Survival (%) For All Cancers
80
Solihull line chart England column chart
75
70
65
60
55
50
45
40
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Communicable Diseases Communicable Disease can be defined as an illness due to a specific infectious agent or its toxic products that come about through transmission of that agent or its products from an infected animal, person or reservoir to a susceptible host either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment. The Health Protection Agency (HPA) have recently made several public health recommendations which include the need for non‐UK born communities to have access to culturally competent and language supported services, and the importance of considering health needs relevant to an individual’s country of birth. The HPA also aim to assist primary care practitioners caring for people who have come to live in the UK from abroad, so as to contribute to the reduction of the burden of infectious disease in the populations that are at highest risk (other groups include homeless persons, problem drug users and prisoners): In 2010, 73% of TB cases reported in the UK, almost 60% of newly diagnosed cases of HIV, and 80% of hepatitis B infected UK blood donors were born abroad. Health risks to the non‐UK born can continue for many years after arrival in the UK. 77% of non‐UK born TB cases in 2010 were diagnosed two or more years after arrival in the UK. Some migrants may have more complex health needs than the UK born population, influenced by the burden of disease and living conditions in their country of origin, experiences during migration, their circumstances in the UK, as well as factors relating to ethnicity and cultural practices. UK residents travelling to visit friends and relatives in their country of origin are the major risk group for UK reports of several important travel associated diseases. 61% of malaria cases reported in the UK in 2010 and 87% of enteric fever cases in England, Wales and Northern Ireland who had travelled abroad between 2007 and 2010, were visiting friends and relatives. 178 Solihull MBC are responsible for the provision of a port health medical facility at Birmingham International Airport. The Public Health (Aircraft) Regulations 1979 require the appointment of an authorised Medical Officer at Birmingham Airport and may be required to board an aircraft if a passenger is suffering from an infectious disease or medically examine a passenger referred by an Immigration Officer. Furthermore, the Local Authority is contracted to visit the airport on a weekly basis to collect the medical forms of all passengers that have been medically examined on arrival at the airport, acting as an agent to Solihull Care Trust to collect information relating to immigrants arriving at the airport and forward relevant information to their destination Primary Care Trusts. There are of course other responsibilities surrounding communicable diseases whereby Public Protection officers in Solihull are also responsible for the enforcement of the Local Government Miscellaneous Provisions Act 1982 in respect of the registration of cosmetic piercers. The registration and inspection process aims to reduce the risk of infection from organisms such as Hepatitis B by ensuring high standards of hygiene, infection control procedures and trained operatives. As at 1st April 2011 there were 68 premises registered. In addition, 129 premises and 209 operators were registered at the NEC. Following attendance at the Beauty Show in 2010, the need for significant improvement in infection control standards was identified, particularly in respect of the provision of correct hand washing facilities. The Public Protection Food and Safety Team investigates notified cases of food borne illness as directed by the Consultant in Communicable Disease Control (CCDC). In the year 2010‐11, 58 notified infectious diseases were investigated within 2 working days of notification. In addition, patients that have been suffering from campylobacter are sent an information leaflet and a surveillance questionnaire to try to establish common possible causes particularly originating from food businesses within Solihull. Suspected cases of food borne illness are investigated as appropriate. Currently, notified cases of infectious diseases are investigated, so as to determine their source, prevent further spread of infection and to provide infection control advice to patients. Although pest control is not a statutory duty it often indicates that wider problems such as rubbish accumulation and poor sanitation exist. However, animal diseases can prove catastrophic and if become zoonotic can cause serious ill health issues and potential death to humans (eg swine and avian flu, rabies etc..). With both European and national legislation in place to try to control such diseases, the Local Authority has an animal health function and duties with the aim of preventing/controlling the spread of animal diseases in both human and animal populations. Disease Prevalence Models The health needs of a population derive from the prevalence of diseases ie the numbers of people suffering from different types of illness. Looking only at the numbers of patients currently being treated for a disease does not show the true prevalence and impact on the population’s health. At any given time there are many people who have a disease but are not aware of it because they have not yet been diagnosed. A robust and well‐researched disease prevalence model can help commissioners to assess the true needs of their community, calculate the level of services needed and invest the appropriate level of resources for prevention, early detection, treatment and care. Prevalence models provide estimates of underlying prevalence derived from population statistics and scientific research on the risk factors 179 for each disease. It should also be noted that many diseases affecting individuals will be long‐term conditions which are chronic illnesses that can limit lifestyle. These include diabetes, heart disease and chronic obstructive pulmonary disease. Numbers are expected to rise due to unhealthy lifestyles and an aging population. Cardiovascular Disease (CVD) Although mortality from CVD in the UK is declining, it continues to be the most common cause of death. More than one in five men and one in six women die from the disease. Around 2 million people aged over 35 suffer from angina, while it is likely that around 146,000 people have a heart attack annually. From 2007‐09, in Solihull Care Trust the percentage of CVD deaths under 75 yrs as a proportion of all deaths under 75 yrs was 31.4% for males and 18.0% for females. This is significantly higher than England for males (28.5%) and significantly lower than England for females (20.1%). CVD is a general term used to describe disorders that can affect the heart and/or the body’s system of blood vessels (vascular). Many cardiovascular problems result in chronic conditions that develop or persist over a long period of time. However, it may also result in acute events such as heart attacks and strokes that occur suddenly when a vessel supplying blood to the heart or brain becomes blocked. CVD occurs more frequently in people who smoke, who have high blood pressure, who have high blood cholesterol, who are overweight, who do not exercise and/or who have diabetes. Both morbidity and mortality vary geographically, with higher rates in the North of the UK compared to the South. There are also socio‐economic and ethnic differences, with higher rates of CVD in manual workers compared to non‐manual workers and higher rates in South Asians compared to the population as a whole. Primary prevention concentrates on altering modifiable lifestyle factors including diet, exercise and obesity as well as stopping smoking and reducing alcohol intake. With the exception of healthy eating, modelled estimates show that the proportion of adults displaying poor lifestyle factors in Solihull are below those for England and the West Midlands. Binge Drink Smoke (all adults) Smoke (Patients with Long‐
Term Conditions)* Do Not Eat Healthily Obese Source: ONS (except * QOF) Solihull 17.6% 15.8% 15.4% 72.4% 23.8% Proportion of Adult Population England West Midlands 20.1% 18.8% 22.2% 21.6% 17.7% 17.5% 71.3% 24.2% 74.3% 26.4% Public health also has a role to play in secondary and tertiary prevention including ensuring appropriate availability of medication as necessary and equity of access to high quality surgical procedures. Under 75 directly standardised CVD mortality rate at 61.7 per 100,000 for 2007‐09 in Solihull is significantly better than the England average of 70.4. This masks a large gap between the most and least deprived quintile, although it should be noted that the mortality rate among the most 180 disadvantaged quintile in Solihull is still below that for the most disadvantaged in either England or the West Midlands. The mortality rate in 2009 for persons who live in the most deprived areas (bottom quintile) of Solihull Care Trust was 111.5 per 100,000. This is 1.8 times greater than the overall mortality rate for Solihull Care Trust and 5.1 times greater than the mortality rate for persons who live in the least deprived areas of Solihull Care Trust. In England the mortality rate for persons who live in the most deprived areas was 115.7, 1.6 times greater than overall and 2.8 times greater than in the least deprived areas. In West Midlands the mortality rate for persons who live in the most deprived areas was 115.0, 1.6 times greater than overall and 2.8 times greater than in the least deprived areas. Also, male CVD mortality rates in Solihull Care Trust are significantly higher than female CVD mortality rates (92.3 and 33.8 respectively). The prevalence estimates (having had CVD including angina, heart attack or stroke) at December 2011 (East of England Public Health Observatory ‐ EEPHO) for the Solihull Local Authority area reveal a rate of 12.2% for persons aged 16 or over, which is higher than England (11.8%) but lower than for the West Midlands (12.4%). Further analysis by major age groups reveals Solihull to be below both England and the West Midlands in all cases. Therefore, the overall rate is affected somewhat by Solihull’s mean age being notably above that of England. This also appears to be evident at practice level with the highest containing a significant proportion of older patients (Bernays & Whitehouse – 14.7%, St. Margaret’s 14.5%, Coventry Road and Chester Road – both 14.3%). Age is a key factor in cardiovascular disease. The prevalence of cardiovascular disease increases significantly after the age of 40 years. In 2009 the percentage of the population aged 40 yrs and over in the Solihull Care Trust area is 25.1% for males and 28.3%. This is higher than both the West Midlands (23.7% and 25.9% respectively) and England (23.4% and 25.7%). Coronary Heart Disease (CHD) As already stated Cardiovascular Diseases are the main cause of death in the UK causing around 156,800 deaths in England in 2008 (around a third of all deaths). Around 45% of all deaths from CVD are from CHD and more than a quarter from stroke (28%), making CHD the most common cause of death in England and Wales (15% of all deaths). In 2007‐09, CHD makes up the biggest proportion of deaths within CVD for both males and females, 21.2% (11.2% Acute Myocardial Infraction (AMI)I and 10% non AMI) and 7.2% (2.6% AMI and 4.6 % non AMI) respectively in Solihull Care Trust. For males, 4.1% of deaths are due to stroke and 0.7% are due to heart failure. For females, 4.9% of deaths are due to stroke and 0.7% are due to heart failure. The 2007‐09 AMI mortality rate for persons under 75 yrs in Solihull Care Trust was 18.2 per 100,000. This is higher than in England (16.3%) and lower than in West Midlands (18.5%). In Solihull Care Trust, male AMI mortality rates are significantly higher than female AMI mortality rates. The forecast decrease in the mortality rate for CHD between 1996 and 2012 for Solihull Care Trust is 60.7% for males and 77.2% for females. For England, the forecast decrease is 65.3% and 72.4% for males and females and for West Midlands it is 67.2% and 74.5% respectively. The prevalence estimates at December 2011 (EEPHO) for the Solihull Local Authority area reveal a rate of 5.9% for persons aged 16 or over, which is higher than England (5.8%) but lower than for the West Midlands (6.5%). In common with CVD, further analysis by major age groups reveals Solihull to be below both England and the West Midlands in all cases. Therefore, the overall rate is again 181 affected by Solihull’s mean age being above that of England. However, practice level prevalence estimates (QOF data) reveal a correlation with deprivation that appears stronger than that of COPD – seven of the highest rated eight cover practices in North Solihull (this also increases the risk of vascular dementia). There is also a gender difference with females in Solihull being in‐line with the England comparison (both 4.7%), whereas males in Solihull are higher at 7.2% compared with 7.0%. The proportion of the population in Solihull Care Trust which is from black and minority ethnic groups (BAME) is estimated to be 12.9%. South Asian men are more likely to develop CHD at younger age and have higher rates of myocardial infarction. Stroke Stroke is a ‘brain attack’ caused by a disturbance to the blood supply to the brain. The most common form of stroke, Ischaemic, is caused by a clot narrowing or blocking blood vessels so that blood cannot reach the brain, which leads to the death of brain cells due to lack of oxygen. Haemorrhagic stroke is caused by a bursting of blood vessels producing bleeding into the brain, which causes damage. Transient Ischaemic attacks (TIA), also known as minor strokes, occur when stroke symptoms resolve themselves within 24 hours. Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England will suffer from a stroke and around 30,000 of these will go on to have a further stroke. Although stroke mainly affects older people, 10,000 people under 55 years and 1,000 people under 30 years have a stroke each year. Prevalence of stroke is between 40% and 70% higher in African‐Caribbean and South Asian men as compared to the general population, whilst unskilled manual workers have a 60% higher chance of having a stroke than those in professional occupations. Health conditions such as hypertension and diabetes, as well as lifestyle factors such as smoking, high levels of alcohol consumption, poor diet and low levels of physical activity also contribute to the risk of stroke. Stroke has a devastating and lasting impact on the lives of people and their families. Individuals often live with the effect for the rest of their lives. A third of people who have a stroke are left with long‐term disability. The effects can include aphasia, physical disability, loss of cognitive and communication skills (e.g. leading to aphasia), depression and other mental health problems. Promoting healthy living is very important in helping to prevent stroke, particularly in disadvantaged areas and groups. Healthy lifestyles and management of specific risk factors reduce the risk of an initial stroke and the risk of a subsequent stroke. It is estimated that 20,000 strokes a year could be avoided through preventive work on high blood pressure, irregular heartbeats, smoking cessation, and wider statin use. The under 75 directly standardised mortality rate of 10.3 per 100,000 for 2007‐09 in Solihull is better than the England average of 12.8 and West Midlands of 13.6. The forecast decrease in the mortality rate for stroke between 1996 and 2012 for Solihull Care Trust is 49.9% for males and 60.5% for females. For England, the forecast decrease is 62.8% and 63.5% for males and females and for West Midlands it is 69.1% and 63.8% respectively. The prevalence estimates (EEPHO) at December 2011 for Solihull reveal a rate of 2.60% for persons aged 16 or over, which is higher than England (2.55%) but lower than the West Midlands (2.85%). Further analysis by major age groups reveals Solihull to be significantly below both England and the West Midlands in all cases. Therefore, the overall rate is affected again by Solihull’s mean age and 182 like CVD highest rated practices (QOF data) again contain a significant proportion of older patients (Chester Road – 3.8%, Craig Croft, Bernays and Whitehouse, Coventry Road and St. Margaret’s – all 3.2%). Hypertension At 33% the estimated prevalence for hypertension (aged 16+) in Solihull is above both the England (30.5%) and the West Midlands (31.7%) averages. One of the key issues in terms of Hypertension is the extent to which the problem is undiagnosed (unmet need). This is shown by comparing the actual number of patients diagnosed with hypertension (QOF GP practice data) against this estimated prevalence. In Solihull, just 15% of registered patients have been diagnosed with Hypertension, half the estimated prevalence in the borough. The estimated percentage of people aged 16 or over with Hypertension is higher in Solihull than for England and the West Midlands but is in‐line with England for all available age groups (EEPHO, December 2011): Persons 16+ White Mixed Black Asian Other 16‐44 45‐64 65‐74 75+ 33.0 34.2 12.9 31.7 21.5 18.4 9.5 39.9 65.1 71.6 31.7 33.0 13.2 32.0 22.5 16.2 9.7 40.7 65.5 72.1 Solihull West Midlands England 30.5 31.7 14.8 29.5 21.0 17.5 9.4 39.8 64.8 71.3 There are no obvious patterns for practices within Solihull, which suggests that unlike other diseases there is no link with deprivation. Nevertheless (similar to COPD), only 10 of the 30 practices within Solihull Care Trust are below the England average – and these 10 are in areas where the population profile is generally younger. This suggests there is a borough‐wide issue here for further exploration 183 that should begin by looking at age profiles but should also consider other demographic factors such as ethnicity. Chronic Kidney Disease (CKD) CKD is internationally classified into five different stages following US National Kidney Foundation guidance ‐ the higher the stage, the more severe the kidney disease. Estimates of glomerular filtration rate (GFR) ‐ a measure of the flow rate through the kidney ‐ are used to determine levels of CKD, as outlined in the following table. Stage of
CKD
1
2
3
4
5
Description
Kidney damage with normal or raised GFR
Kidney damage with mildly reduced GFR
Moderately reduced GFR
Severe reduction in GFR
Kidney (renal) failure
GFR
(ml/min/1.73m2)
>90
60-89
30-59
15-29
<15
The QOF prevalence rate for stages 3‐5 at 3.6% of the GP registered population aged 18 and over for Solihull (APHO, 2009) is below that of England (3.7%) and the West Midlands (3.9%). However, the modelled estimate (which includes those undiagnosed) at 9.8% is above both the West Midlands (9.1%) and England (8.8%). This equates to some 15,459 people aged 18 or above of which 10,092 are female. This suggests a gap for unmet need in the order of 10,000 adults. Respiratory Disease Approximately 8 million people in the UK are affected by chronic lung diseases, most of these are either asthma or chronic obstructive pulmonary disease (COPD). Respiratory disease is a ‘hidden disability’. People with lung disease can experience severe restrictions on their mobility and ability to undertake day‐to‐day activities, such as getting dressed or cooking a meal. There are a wide range of other factors which impact on lung health, including smoking; viral lung infections and inadequate lung development in childhood; passive smoking; genetics; air pollution; occupational exposure to materials such as dust, asbestos fibres and other irritant particles. Nutrition and social deprivation are also factors for lung health. There are more than 40 conditions which affect the lungs and/or airways and impact on a person’s ability to breathe. They include lung cancer, tuberculosis, asthma, COPD (chronic obstructive pulmonary disease), cystic fibrosis, sleep apnoea, avian flu, bronchiolitis and many others. The UK’s death rate from respiratory disease is almost double the European average and the 6th highest in Europe. Respiratory disease is the second most common illness responsible for emergency admission to hospital. There are an estimated one million admissions a year for respiratory disease in the UK suggests at a cost of £1,496.4 million to secondary care. Respiratory disease costs the NHS and society £6.6 billion, £3 billion in costs to the care system, £1.9 billion in mortality costs and £1.7 billion in illness costs. An estimated 24 million consultations with GPs were for respiratory disease in 2004 at a cost of £501 million to primary care. 184 Chronic Obstructive Pulmonary Disease (COPD) The estimated percentage of people aged 16 or over with COPD is higher in Solihull than England for all available age and ethnicity groups (EEPHO, December 2011): Males Females Persons White 16+ 16+ 16+ * Black Asian 16‐44 45‐64 65‐74 75+ 5.16 3.58 4.33 4.44 4.18 2.48 1.32 4.59 9.30 10.24 4.94 3.07 3.98 4.07 4.83 2.66 1.36 4.46 8.86 9.63 Solihull West Midlands England 4.49 2.82 *including Mixed and Other 3.64 3.71 4.06 2.33 1.28 4.15 8.31 8.94 There is a clear suggested correlation with increasing deprivation for practices within Solihull, as all that cover North Solihull are above the borough rate. Nevertheless, only 8 of the 30 practices within Solihull Care Trust are below the England average – largely covering the most affluent areas. This suggests there is a borough‐wide issue here for further exploration that is not easily explained by age or deprivation. Diabetes Diabetes is a health condition of increasing concern. The prevalence of diabetes is increasing as obesity levels increase and overall physical activity levels remain low. Diabetes is caused by too much glucose in the blood, which can cause damage to nearly the whole body. There are two types: Type I (usually affecting children and young people – note that for the 2009 National Child Measurement Programme, Solihull Care Trust did not have significantly different levels of obesity in Year 6 pupils compared to England) where cells producing insulin are destroyed, and Type II where the body does not respond well to its own insulin. Type II accounts for 90% of all diabetes, and increases steadily after the age of 45. It is linked to: 







Increasing age Ethnic origin Family history Increasing levels of obesity and overweight Low levels of physical activity Calorie intake from food Socio‐economic deprivation Gestational diabetes (occurring during pregnancy) Around 3% of people in England are known to have diabetes; however it is estimated that another 1.4% of the population are undiagnosed. Among the nine English regions, the North East has the highest estimated prevalence: 4.73% and the South East the lowest: 3.86%. The proportion of the population with diabetes is predicted to rise due to the combined effects of an ageing population and predicted increases in obesity levels. Diabetes already costs the NHS an estimated £5m per day. Middle‐aged and older populations and people of South Asian or African‐Caribbean origin are most at risk of developing this chronic and progressive disorder. Black and South Asian people have 4 ‐ 6 times higher rates of diabetes than white Europeans. Estimated prevalence of Type II Diabetes is 185 m
ed fifth of thhe population, compared
d to Englandd as a whole
e (people 35% higgher in the most deprive
living in the 20% most deprived
d neighbour hoods in England are 56
6% more likeely to have diabetes than tho
ose living in tthe least dep
prived areas)). Across Enggland people
e with diabettes are twice
e as likely as people without th
he condition to die betweeen the agess of 20 and79
9 years. Diabetess can be prevented by increasing ppublic aware
eness of the
e condition aand early syymptoms (such ass increased th
hirst, blurred
d vision). Peoople at risk n
need to be su
upported to change theirr lifestyle by losing weight, increasing phyysical activitty and eatingg a healthier diet. Enviroonmental an
nd policy changess to tackle ob
besity and to
o improve leevels of physsical activity are vital for diabetes prevention too. Diaabetes can be b well‐conttrolled and treated, thu
us delaying and even ppreventing lo
ong‐term complicaations. However if diabetes is not m
managed we
ell it can lea
ad to seriou s conditionss such as heart dissease and stroke, kidneyy failure, eye disease, lim
mb amputatio
ons and menttal ill‐health. In 2009‐‐10 there weere 9,538 peo
ople aged 177 years and o
older diagnossed with dia betes in Solihull Care Trust. TThere are alsso an estima
ated 2,971 addults with undiagnosed diabetes. Thhis represen
nts a rate of 5.4% diagnosed diabetes wh
hich is in‐linee with Englaand but the total estim ated rate off 7.6% is of England (7
7.4%). The cchart below sshows the in
ncidence of ccomplicationns as recorde
ed in the ahead o
Hospitall Episode Staatistics per 1
1,000 peoplee with diabettes (note tha
at Solihull is a designate
ed Yellow group w
which have a greater prop
portion of thhe population aged 40+ yyears with geenerally low levels of deprivattion): In Solihu
ull Care Trustt 52.3% of all people wit h diabetes aged 17 yearss and older hhave a HbA1c (a form of haem
moglobin thaat is measurred primarilyy to identifyy the average plasma gl ucose conce
entration over pro
olonged periods of time)) of 7% or leess. This is sttatistically siignificantly loower than P
PCTs with populatiions with sim
milar diabete
es risk factoors and statisstically signifficantly loweer than England as a whole. The APH
HO Diabetess Prevalence
e Model proovides estim
mates of tota
al (diagnoseed and undia
agnosed) diabetess prevalencee for people aged 16 yea rs and olderr up to 2030.. The rate inn Solihull is p
projected to increaase from 7.7
7% to 9.8% o
over the peri od (from 2011) compare
ed with 7.5%
% to 9.5% forr England and 8.2%
% to 10.4% ffor the West Midlands. In terms off persons thiis representss an increase
e of 43% from 12,791 in 2011
1 to 18,296 b
by 2030. It iis not known
n why the ra
ate for Solihuull is currenttly higher than En
ngland and why w the gap
p is set to ggrow. A like
ely explanatiion is that SSolihull has and will 186 continue to have a relatively older population than the England average, although further analysis is worthwhile. Genetics and Genomics A recent DoH Task and Finish Group report on Genetics/Genomics in Nursing and Midwifery (2011) suggests that healthcare commissioners, providers and practitioners need to understand the relevance of genomic science to current healthcare practice and to recognise its future potential in delivering more effective healthcare, including: 
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diagnosis of genetic subtypes of common diseases such as diabetes, Alzheimer’s disease, Parkinson’s disease and several types of cancer; identification of population sub‐groups who are at increased risk where there is opportunity for primary and secondary prevention; and advance strategies for disease prevention and public health. Although the report also notes that the application of genomic science carries significant risks, notably in ethics. Green et al. (2011) comment that the current era is characterised by the growth in understanding of the biology of disease, which in turn becomes the basis for improving health, as exemplified by Crohn’s disease, type 2 diabetes and age‐related macular degeneration. However, they also caution that although genomics has already begun to improve diagnosis and management for some conditions, ‘profound improvements in the effectiveness of healthcare cannot realistically be expected for many years’ (Green et al. 2011, p 204). Even so, technology developments, which they describe as being both revolutionary and evolutionary, will continue to drive genomics advances. They present five imperatives that will be able to capitalise on these and other opportunities afforded by the growth in understanding into disease biology over the coming decade: 1.
2.
3.
4.
5.
Making genomics‐based diagnostics routine. Defining the genetic components of disease – from the rare Mendelian to common complex disorders such that the genetic variation underlying the full spectrum of diseases is determined. Comprehensive characterisation of cancer genomes – leading to more robust diagnostic and therapeutic strategies. Practical systems for clinical genomic informatics to provide readily accessible information that can be reviewed as knowledge evolves. The role of the human microbiome in health and disease – to investigate how the microbiome may be manipulated as a new therapeutic approach. The House of Lords Science and Technology Committee (2009) conducted a comprehensive inquiry into genomic medicine and noted the increase in the number of private companies offering individual genetic tests or entire genomic profiles for sale directly to consumers (DTC tests). Typically, these are found to be available through the Internet. This may be in response to an increase in demand for and expectations of, testing and genetic health services within the general population. It is believed that the ‘hype’ surrounding early discoveries has led to some disappointment since clinical translation has not been immediately realised. There remains uncertainty over the scale and 187 pace of discovery but the accelerating pace is acknowledged by authors such as Green et al. (2011) and in the review of the Genetics White Paper (Department of Health 2008). The Royal Society (cited in DH 2008, p27) captures this succinctly: “Increased knowledge of genetics and genomics in the long term will impact substantially on the way in which we understand and treat disease; the impact on healthcare is just beginning and will not be dramatic over a short timescale. Instead, new diagnostic treatments and new disease classifications will emerge with increasing frequency but will not change the basics of clinical care overnight.” Nonetheless there has been a significant impact on healthcare already, particularly in relation to increases in referral rates to specialist genetics services from primary care and other ‘mainstream’ services, and in care delivery in other specialisms such as cancer services and initiatives such as expanded newborn screening, and cascade testing for familial hypercholesterolaemia. The report also notes that by 2001 it was already clear that the NHS was unable to keep pace with this increase in activity, and that the gap between demand and delivery would grow without targeted intervention, requiring substantial investment by the UK government (DoH 2008). The implications for healthcare are indicated in that investment strategy: the need to strengthen specialist genetics services, the need to build genetics/genomics into mainstream services and the need to ensure that the healthcare workforce is knowledgeable and competent to deliver care that incorporates genetics/genomics. Furthermore, understanding the science of genomics presents a particular challenge for healthcare professionals as science teaching is regarded as ‘the singularly most problematic area of the curriculum’ (White and Ousey 2010). Priorities for Commissioning •
Implement targeted prevention and treatment services to reduce premature mortality from heart disease and stroke; •
Expand comprehensive integrated lifestyle management services and improve access through the use of single point of contact arrangements; •
Expand comprehensive Vascular Checks programme to reduce level of unmet need; •
Development of services for the prevention and treatment of alcohol misuse; •
Ensure that services and initiatives are progressively provided in relation to need to reduce the gap in life expectancy; •
Social marketing and engagement programmes. 188 HealthProtectionAnnex
Gastrointestinal Infections Gastrointestinal diseases are caused by a variety of organisms and can lead to stomach upsets, diarrhoea and vomiting. They can be acquired in a variety of ways ‐ through eating contaminated food, drinking contaminated water and coming into contact with contaminated surfaces. Person to person spread occurs by one person passing the infection on to others either through contaminated hands or clothes. As many as 1 in 5 members of the population are affected by infectious gastrointestinal disease each year. Although most people recover from gastrointestinal disease within a few days it can have serious consequences in the very young and very old. It also impacts on local economies through days lost working and can put a burden on local health services. In general, for most diarrhoeal diseases people have to stay away from work/ education for a minimum of 48 hours after symptoms have ceased and for some diseases exclusions can be for longer periods. This results in loss of working/ study time. In terms of the demand on various services, the minimum intervention entails communication and reporting between the diagnosing doctor, the laboratory, Health Protection professionals and Environmental Health Officers. This involves reporting, enquiries, investigations and follow up with varying degrees of complexity. Where needed certain people involved in particular occupations or educational activities often have to be excluded until complete recovery is made. Areas which have a rate of over 330 cases per 100,000 population in 2010 are considered to be higher than the national average. The rate of laboratory confirmed cases will vary from area to area for several reasons such as whether healthcare professionals take samples or whether people present to their GPs, as well as an actual higher incidence of gastrointestinal disease. The rate of infection will also vary due to weather, season and food hygiene practices. In Solihull, the rate of laboratory confirmed cases was 277 per 100,000 population in 2010. (Source: HPA LabBase.) Although this does not cross the threshold of 330 cases per 100,000 it is never the less the highest in the West Midlands. The two commonest causes are Campylobacter (this is rising) and Salmonella (this is showing a gradual reduction). Note that Typhoid, Paratyphoid and Hepatitis A have not occurred in great numbers but involve urgent responses and a lot of work by many professional groups when they occur. Food Safety – Prevention of Ill Health through Food and Water There are National campaigns such as Scores on Doors and various initiatives by the Food Standards Agency that have contributed to a reduction in food poisoning and an increase in the quality of food. Public awareness of food hygiene and personal precautions could be a major contributing factor to further reduction. In particular, awareness of hand hygiene, safe handling of food, availability and uptake of vaccination will help to maintain good health and wellbeing. Consulting the GP or the Pharmacist prior to travelling so that timely advice and immunisations can be obtained is crucial to reducing the number of infections. 189 Prevention of spread involves early recognition by affected individuals and can only result through better awareness. Equally, it is important for diseases to be recognised and investigated early and therefore professionals should maintain a high index of suspicion. They should also notify the disease as early as possible so that the chances of identifying a possible source are maximised and that measures are put in place to prevent further spread from affected individuals. In 2011 the Food Standards Agency estimated that each year in the UK, approximately one million people suffer from food borne illness of which, 20,000 people receive hospital treatment and 500 die. The estimated cost of this per year is £1.5 billion. In Solihull there are 1,724 known food businesses which are subject to inspection according to their risk ratings determined by the Food Law Code of Practice (to ensure compliance with food safety and food standards legislation). This can range from an inspection every six months to an inspection every two years dependent on risk. Lower risk premises receive an intervention from the team every three years. In 2011/2012, 696 food hygiene inspections were carried out; some of these premises would have received further visits by officers until acceptable standards of hygiene were achieved. It is worth noting that there are seven approved premises within Solihull, which are for those premises which for a variety of reasons would pose a higher risk to public health should a problem occur e.g. due to their size, the extent of the business or the nature or complexity of the food business operation – these include dairy production, cheese and baby food manufacture, manufacture of meat products and catering for airlines, hospitals and children’s nurseries. Scores on the Doors is a scheme currently operated to encourage improved standards of hygiene and provides consumers with information regarding the food hygiene standards of food businesses (approximately 600 caterers handling and preparing high risk foods for the public). This allows consumers to make an informed choice about where they eat. Following a routine food hygiene inspection, businesses are awarded a food hygiene rating between “0” to “5”. A zero rating indicates a very poor level of food hygiene with the top rating “5” represents a “very good” level of food hygiene compliance. The scheme has been successful in encouraging businesses to improve their hygiene standards. The percentage of food businesses that are “broadly compliant” with food hygiene legislation in Solihull has risen from 88% in 2010/11 to 93% in 2011/12. It is notable that the regeneration area has a premises profile of 10.5% zero to one star rated premises (versus a Solihull average of 6.3%). Officers in Public Protection’s Food and Safety Team carry out inspections, investigations and regularly participate in sampling programmes for food labelling and composition which aim to determine levels of compliance with food standards legislation. Through sampling the following were also found: a survey of food contact materials found migrating plasticisers (probable carcinogens) in some cooking utensils that subsequently generated a national withdrawal of affected cooking equipment and subsequent tighter legislative standards; a survey of lightly cooked foods from local premises found unacceptable microbiological levels in some samples this was followed up with advice to premises on hygiene and safe food preparation. A survey of cleaning cloths and hygiene standards found microbiological failures in some retail and catering premises. This was followed up with advice to these premises to improve standards. Sampling of take away food has focused on the levels of artificial colours in food. High levels of artificial additives can have a long term affect on health and food colours have been linked to hyperactivity in 190 children. The Food Standards Agency also advises of emerging risks with ochratoxins in fruit and vegetables (risk from inadequate storage) and acrylamide in fried foods (not expected from typical exposures in foods). The Food and Safety Team are responsible for the control and inspection of food products (not of animal origin) imported through Birmingham airport cargo. 50% of food consumed in the UK is imported. The majority of foods that are imported are wholesome and safe but it is important to have effective imported food controls in place to ensure that consumers and food businesses are protected from contaminated products. Recommendations It is important to continue public awareness campaigns regarding hand hygiene, food hygiene, travel precautions as well as the need to prevent spread to others (such as in certain occupations). Clinicians need continue to investigate early and notify any suspicion of infectious gastrointestinal disease in a timely manner. 

a) Screening b) Immunisations Immunisation programmes in the UK may be broadly grouped according to age groups: children, teenagers and adults and those who are at greater risk of vaccine preventable diseases. Each age group comprises of many different vaccines according to the national schedule. The World Health Organisation recommends that at least 95% of children should receive three primary doses of Diphtheria, Tetanus, Acellular Pertussis (Whooping Cough) and inactivated Polio (DTaP/IPV/Hib) vaccine in the first year of life and at least 95% should receive a first dose of Measles, Mumps and Rubella (MMR) vaccine by two years of age. In addition, at least 90% should receive a booster dose of Diphtheria, Tetanus and Polio between 13 and 18 years of age. In the UK the universal childhood immunisation programme also includes vaccination against Haemophilus Influenzae type B, Pneumococcal infections, Meningitis C, and a second dose of MMR vaccine. In the UK, the success of vaccination programmes has led to the virtual disappearance of some diseases and a significant reduction in mortality and morbidity. However re‐emergence of vaccine‐
preventable diseases has been demonstrated where uptake has fallen. For example, owing to public anxiety about the safety of the measles, mumps and rubella vaccine in 1998 a reduction in uptake of the vaccine has resulted in the re‐emergence of measles and mumps in recent years. 


In Solihull, trends in uptake of all of the DTaP/IPV/Hib vaccine have generally been above the 95% target for each quarter from April 2008 to September 2010. In autumn 2008 the Department of Health announced the introduction of human papilloma virus vaccine (HPV) for girls aged 12 to 13 years old, the aim being to reduce the incidence of cervical cancer and associated morbidity and mortality. Solihull reported 90% uptake of the HPV vaccine in 2010. In 2010 a survey was carried out with regard to the BCG vaccination of babies at risk of TB and care pathways developed. 191 Challenges Following alleged concerns around the safety of the measles, mumps and rubella (MMR) vaccine in 1998, there was a decline in the number of children receiving the vaccine. This has resulted in an increasing number of children and young people who are susceptible to measles, mumps and rubella and consequently there has been an increase in the number of cases of these three diseases. 



In Solihull the adverse publicity about the MMR vaccine has had a lasting impact on MMR uptake, particularly the second dose by five years. Rates in Solihull continue to be significantly below the other universal childhood immunisation. In the UK the adult vaccination programme comprises vaccination against influenza and pneumococcal diseases for all adults over 65 years of age. Influenza and pneumococcal vaccine is also offered to under‐65 year olds with defined underlying conditions because they are at risk from the complications. Those at risk include people of any age (including children over 6 months of age) with a serious medical condition, particularly those with serious heart or respiratory disease, diabetes, kidney or liver or lowered immunity due to disease or treatment. For Solihull, data from the last annual survey shows that uptake of seasonal influenza vaccine in the over 65s achieved 72%, higher than the target of 70%. Uptake of seasonal Influenza vaccine in the under 65s with defined underlying conditions remained at 49.9% for 2009/10. With regard to the delivery of immunisation services, the context around immunisation is becoming increasingly complex with the need for specialist knowledge and skills. Ensuring public and professional confidence is critical to the success of immunisation programmes. Inequalities in uptake of vaccination It is important to realise that even when a high vaccination uptake is achieved across a geographical area there will be groups of children, young people and adults who cannot be immunised because of contraindications or underlying conditions and who are therefore at risk. National evidence shows that inequalities in immunisation uptake are persistent . Evidence shows that children with incomplete immunisations are more likely to live in disadvantaged areas and are less likely to use primary care services. They also tend to have younger mothers or lone parents, come from larger families, and as babies had a least one hospital admission. In contrast, un‐immunised children are more likely to have older, more highly educated mothers who have made an active decision not to have their children immunised. It is vitally important to emphasise the continuing need to achieve high uptake of vaccines in order to prevent the re‐emergence of vaccine preventable diseases in our local communities. There is a need to develop and improve immunisation services to groups where there is greater vulnerability. These include pregnant/postnatal women, asylum seekers, traveller families, homeless families, looked after children/children in care, children with physical or learning difficulties, children of teenage or lone parents, children not registered with a GP, younger children from large families, children who are hospitalised and some ethnic groups. With regard to provision of high quality immunisation services, It is important to ensure that all staff involved in immunisation services are appropriately trained according to need and in line with HPA 192 National Minimum Standards for Immunisation Training and the HPA Core Curriculum for Immunisation Training supported by NICE Guidance ‘Reducing the difference in the uptake of immunisations’. Healthcare ‐ Public Health and Preventing Premature Mortality Through food standards inspections, Public Protection’s Food and Safety Team advise caterers in a wide variety of settings from nursing homes and nurseries, to fish and chip shops and takeaways. During these visits, traders could also be given advice about healthier food choices, pass on information about reducing salt, sugar and fat in recipes and discuss the possibilities of providing customers with healthier food choices. The mix of shops in deprived areas is weighted towards fast food outlets offering unhealthy food options. Low income groups are more likely to consume unhealthy food choices than higher income groups. This affects levels of obesity. The increase in obesity levels has been outside the professional social grade. (Health Survey for England, National Obesity Observatory). Therefore it is recognised that education in nutrition and balanced eating is becoming increasingly important. The team work liaise with organisations such as CEnTSA (Central England Trading Standards Authorities) to identify any potential initiatives or joint working opportunities. It is likely that this will be an area of increasing importance particularly in light of the public health agenda. A strategy could be devised to integrate policies on healthy eating and planning in target areas to address the accessibility of fast food close to schools and colleges to address childhood obesity. In 2011/12 the team took part in “Truckers Tucker” a healthy eating project involving a truck stop café. The aim of the project was to advise the business on ways of making healthier meals for instance reducing levels of fat and salt. It is possible that if successful this project could be expanded to other similar premises. Consideration will be given to the extension of the Scores on the Doors scheme to encourage caterers and other food businesses to provide a wider range of healthier food choices and healthier recipes Previously, additional funding has enabled work to be done with teenagers to help them make healthier choices, through “make and taste” sessions and quizzes on understanding food labels. It has been recognised that there is potential to strengthen public health impact by rewarding food businesses that provide healthier food options through award schemes, etc. Health Protection Regulations came in to force on the 1st January 2010 requiring Local Authorities to; conduct risk assessments, investigations and examine and analyse water samples in relation to private water supplies. Private water supplies come from ground waters, deep wells, and springs or bore holes and can be contaminated with chemicals or micro organisms depending on the quality of the supply and any water treatment facilities. The risk assessment and analysis seeks to establish that the water quality is wholesome i.e. that it is fit to drink. Officers have the power to require remedial action to ensure that water meets the required standard. The Local Authority has a duty to carry out a risk assessment of large supplies within 5 years (by December 2014) and every five years thereafter. Monitoring of these supplies will take place on an annual basis through sampling. In January 2011 193 Solihull had 15 single dwellings with private water supplies, 3 large supplies with private water supplies (‘commercial activity’) and 5 premises classed as having private distribution systems. It is expected that with the integration of Public Health within local authorities that opportunities for multi disciplinary initiatives will increase. The Food and Safety Team in liaison within Trading Standards and HMRC carried out a survey in 2011/12 of licensed premises and found a level of 16% non compliance with regard to spirits sales such as counterfeiting and avoidance of duty. This has clear health impacts whereby a concerted approach from all partners could further help to mitigate the most harmful effects that consumers might face (counterfeit alcohol [vodka] containing methanol when denatured with ethanol can be fatal and can cause blindness) . It is also difficult to differentiate from alcohol. Health & Safety ‐ Preventing Injury and Ill Health Officers from the Local Authority Food and Safety Team investigate notifications of major injury incidents and fatalities affecting workers in the work place (around 220 health and safety inspections per year from approximately 3,000 premises). The prevention of ill health through the investigation of accidents and dangerous occurrences aims to reduce the likelihood of further injury or ill health. According to the Health and Safety Executive, in 2010/11, 1.2. million people suffered from work related illness and 26.4 million working days were lost due to work related illness. In 2009/10 the cost of work place injuries and ill health cost society an estimated £14 billion. There is a further responsibility for the prevention of ill health through the inspection of high risk or poor performing businesses with regard to health and safety. 136 health and safety inspections were carried out in 2011/2012. Local Authority officers visit high risk workplaces to provide guidance and advice on effectively managing health and safety in the workplace and therefore reducing the likelihood of accidents or occupational diseases to the workforce (this includes stress, back and limb injury). Current initiatives being undertaken relate to Liquefied Petroleum Gas – national replacement of buried metallic pipework project prevention of explosion, laser safety in the beauty industry and gas safety at take away food businesses. These initiatives will be continued into 2012/2013. In 2012/2013 the team will undertake the following additional initiatives. E.Coli at Open farms The Health and Safety Executive has produced a guidance document “Preventing or controlling ill health from animal contact at visitor attractions“ with a supplementary guidance document for teachers co‐ordinating visits to such premises. The team will undertake visits to appropriate premises including exhibitions at the NEC where animals are present to ensure that the guidance is adhered to. Officers will work in partnership with the Council’s internal health and safety team, to ensure that relevant information can be disseminated to schools and nurseries groups within the Borough for which health and safety is not enforced by the Team. Asbestos Duty to Manage The Team will also undertake an initiative to raise awareness of asbestos issues in the workplace. Officers will work in partnership with individual businesses and management companies to raise awareness of asbestos. Sunbed Safety The link between UV light and skin disease, particularly skin cancer is well documented. Solihull is in the 25 percentile for skin melanomas. New legislation, the Sunbed 194 (Regulations) Act 2010 makes it illegal for under 18’s to use commercial tanning equipment and new guidance has been produced for salon owners has been produced. The aim of this initiative is to ensure that tanning salons in the Borough are operating safely to prevent the risk of accident and short/long term ill health. Lasers and Noise in the Entertainment Industry The Control of Artificial Optical Radiation at Work Regulations 2010 relates to lasers and other potentially hazardous light sources in the workplace. The Noise at Work Regulations 2005 came fully into force in 2008 after an initial lead‐in period. An initiative is to be devised during 2012/13 to raise awareness of these two areas in relevant businesses. The Health and Safety Executive website quotes some 17,000 people in the UK suffer deafness, ringing in the ears or other ear conditions caused by excessive noise at work. Slips and Trips in Kitchens Interventions with respect to slips and trips have been undertaken by the team in previous years. However, the team have recently noticed a rise in the number of accidents relating specifically to accidents around dishwasher areas within kitchens across a number of premises. This increased local incidence of slips has highlighted the need to ensure that this particular intervention area will be revisited. Prevention of Ill Health through Infection Control Officers in the Food and Safety Team are also responsible for the enforcement of the Local Government Miscellaneous Provisions Act 1982 in respect of the registration of cosmetic piercers. The registration and inspection process aims to reduce the risk of infection from organisms such as Hepatitis B by ensuring high standards of hygiene, infection control procedures and trained operatives. As at 1st April 2012 there were 72 premises registered and 228 operators registered. In addition, 131 operators were registered at the NEC. Following attendance at the NEC Beauty Show in 2011, the need for significant improvement in infection control standards was identified, particularly in respect of the provision of correct hand washing facilities. Public Protection’s Food and Safety Team investigate notified cases of food borne illness as directed by the Consultant in Communicable Disease Control (CCDC). In the year 2010/11, 349 notified infectious diseases were investigated within 2 working days of notification. In addition, patients that have been suffering from campylobacter are sent an information leaflet and a surveillance questionnaire to try to establish common possible causes particularly originating from food businesses within Solihull. Suspected cases of food borne illness are investigated as appropriate. Currently, notified cases of infectious diseases are investigated; so as to determine their source, prevent further spread of infection and to provide infection control advice to patients. Solihull MBC is responsible for the provision of a port health medical facility at Birmingham International Airport. The Public Health (Aircraft) Regulations 1979 require the appointment of an authorised Medical Officer at Birmingham Airport and may be required to board an aircraft if a passenger is suffering from an infectious disease or medically examine a passenger referred by an Immigration Officer. Furthermore, the Local Authority is contracted to visit the airport on a weekly basis to collect the medical forms of all passengers that have been medically examined on arrival at the airport, acting as an agent to Solihull Care Trust to collect information relating to immigrants arriving at the airport and forward relevant information to their destination Primary Care Trusts. 195 The Health Protection Agency (HPA) have recently made several public health recommendations which include the need for non UK born communities to have access to culturally competent and language supported services, and the importance of considering health needs relevant to an individual’s country of birth. The HPA also aim to assist primary care practitioners caring for people who have come to live in the UK from abroad, so as to contribute to the reduction of the burden of infectious disease in the populations that are at highest risk (other groups include homeless persons, problem drug users and prisoners). Health risks to the non UK born can continue for many years after arrival in the UK. 77% of non UK born TB cases in 2010 were diagnosed two or more years after arrival in the UK. Some migrants may have more complex health needs than the UK born population, influenced by the burden of disease and living conditions in their country of origin, experiences during migration, their circumstances in the UK, as well as factors relating to ethnicity and cultural practices. UK residents travelling to visit friends and relatives in their country of origin are the major risk group for UK reports of several important travel associated diseases. 61% of malaria cases reported in the UK in 2010 and 87% of enteric fever cases in England, Wales and Northern Ireland who had travelled abroad between 2007 and 2010, were visiting friends and relatives. Prevention of Ill Health through the Provision of a Clean Environment Environmental conditions (water/air quality, green space/bio‐diversity, flood risk, litter and landfill) – in the most deprived areas 45% of the population experience 2 or more unfavourable conditions compared with less than 5% in the least deprived areas (Defra). Pollution (including carcinogenic chemicals) – poorer communities on average experience higher concentrations of pollution and particulates with a subsequently higher prevalence of cardio‐
respiratory diseases. Road traffic emissions are the key source of local air quality pollutants in Solihull. Locations with high traffic volumes and congestion are subject to the greatest amount of air pollution. As a consequence those who live near these roads are at increased risk of ill health and early death. Congestion results in higher pollutant emissions, as emissions from vehicles are high when travelling at slow speeds. The dispersion of air pollution is another factor in determining areas of poor air quality; in narrow high‐sided streets the dispersal of pollution can be limited resulting in high pollutant concentrations. Although there are no Air Quality Management Areas in Solihull (largely due to the rural and suburban nature, with few dwellings near to busy roads or junctions) and no predicted exceedances of standards at current receptor locations, there are still hot spots of potentially poor air quality. No sensitive or inappropriate developments (that might make pollution worse) should take place in these areas, and the environmental impact associated with development must be adequately assessed and controlled. Furthermore, Solihull MBC is working with the other West Midlands Metropolitan Authorities to develop low emissions strategies for vehicles, especially large diesel engine vehicles like buses and lorries. This includes encouraging the use of cleaner vehicles rather than penalising dirty ones, a London style low emission zone is not presently envisaged. It should be 196 recognised that nationally DEFRA have acknowledged a long term increase in ground‐level ozone from 38 μg m‐3 in 1987 to 58 μg m‐3 in 2011. Health effects can include respiratory symptoms and inflammation of the airways. Poor air quality impacts upon health, particularly in those sections of the population that are more susceptible such as the young, the elderly, or those suffering from heart or lung related disease. The House of Commons Environmental Audit Committee 2010 identified that the largest cost associated with poor air quality is the adverse affect on human health (House of Commons, 2010). The two key local air pollutants of concern are nitrogen dioxide (NO2) and particulate matter of aerodynamic diameter less than or equal to 10µm (PM10). The main source of NO2 emissions is road traffic; NO2 is an irritant gas which can damage respiratory cell membranes, exposure to high concentrations can produce airway inflammation, severe lung damage, severe difficulty breathing or even death. Studies have demonstrated that high NO2 concentrations in residential areas contribute to increased heart and lung related diseases and deaths (Chaloulakou et al., 2008). The main source of PM10 concentrations is road traffic: fine particles can penetrate deeply into the lung. Adverse health effects include decreased lung function, increased experience of symptoms and medication use in those with lung diseases, increased hospital admissions and mortality (Neuberger et al., 2004). Other local air pollutants across Solihull include ozone, polyaromatic hydrocarbons, volatile organic compounds, sulphur dioxide, carbon monoxide, lead, benzene and 1,3 butadiene. The adverse impact upon health from these pollutants can be compounded by exposure to a mixture of air pollutants. The Ambient Air Quality Directive (2008/50/EC) (European Parliament, 2008) and the fourth Air Quality Daughter Directive (2004/107/EC) (European Parliament, 2004) are the principal instruments governing outdoor air pollution policy across the European Union. The UK currently meets all EU air quality limit values except those for PM10 and NO2. Part IV of the Environment Act 1995 (DEFRA, 1995) requires Local Authorities to regularly review and assess air quality within their administrative area. Review and assessment of air quality must take into account the statutory Air Quality Objectives contained in the National Air Quality Strategy 2007. The Air Quality Regulations (England) 2000 and the Air Quality (England) (Amendment) Regulations 2002 set specific concentration limits for seven pollutants, with required compliance dates. All seven national air quality objectives are based upon the relevant pollutant’s effect on health. Should the review and assessment process identify areas where the objectives are likely to be exceeded the Local Authority must declare an Air Quality Management Area (AQMA). An action plan must then be prepared showing how the Authority intends to improve air quality in these areas. What can we do to address air quality issues in Solihull? Various departments of the Council lead on action to improve air quality but require the support of key partners including: DEFRA, the Environment Agency, the Highways Agency, the Health Protection Agency, Neighbouring Authorities, CENTRO, Travel West Midlands, the Road Haulage Association, Friends of the Earth and developers working across Solihull. Currently there is no formal multi agency air pollution group though the West Midlands local authority air quality officers meet 197 regularly to discuss decisions or actions relating to air quality and other agencies attend these meetings as required. As with other areas of health protection there are costs associated with implementing measures to improve air quality. However significant benefits with associated cost savings can be derived from reducing deaths and disease associated with poor air quality and through complying with EU requirements (the UK faces a possible fine of up to £300 million for non‐compliance). Although air quality in Solihull does not breach the national air quality objectives there is still value in improving air quality as research into the health effects of poor air quality has demonstrated that there is no entirely safe concentration of air pollution, consequently there is still value in reducing pollutant concentrations that are already below national objective levels. Priority areas for action are firstly increasing public awareness of the problem and involvement in the solution and secondly increasing multi‐agency involvement in the air pollution problem. Specific priority actions include the increased promotion and establishment of Travel Plans, and the establishment of new and improvement of existing Walking and Cycling Schemes across the City. Through influencing the decisions members of the general public make every day with regard to transport mode selection, significant reductions in emissions can be achieved, resulting in health benefits for all Solihull residents. The overarching indicator of success for all Strategy Objectives will be an improvement in air quality across Solihull, thus reducing exposure to pollutants for people; which will in turn improve their health reduce deaths and also reduce the costs of their healthcare to the NHS. Specific actions to achieve this are recommended in the following table. Challenges in
Solihull
Recommended
lines of Action
Partners (lead
underlined)
Solihull MBC produced
both a walking and a
cycling strategy in
2009.
Significant cost
implication of
implementing
and running
promotional
schemes.
Increase input
from partner
organisations in
the promotion and
development of
schemes to
promote both
walking and
cycling.
LA
Businesses
and
organisations
in Solihull
On-going
Current status in
Solihull
Time-scale
The recommended objective is to increase multi‐agency involvement in dealing with air pollution. The following table sets this alongside the current status and challenges in Solihull, recommended lines of action for achieving objectives, timescale and indicators for success related to air quality: Recommended
Indicator for
success
>2 new schemes
established in each
year.
Public
198 Partners (lead
underlined)
Solihull Council has
devised its own Green
Travel Plan for council
staff.
Resources are
required to
establish and
maintain a
Travel Plan
effectively.
Increase
promotion and
establishment of
Travel Plans
amongst
organisations
(schools and
employers) across
Solihull including
walking and
cycling
programmes.
LA
Cost
implications and
public resistance
to modal shift.
Ensure proposed
public transport
improvements go
ahead as planned
and that
momentum to
improve service
provision is
maintained.
LA
Schemes are in place
in Solihull to improve
public transport such as
the scheme around the
NEC and airport
including a new
interchange, new bus
stops and
improvements for
disabled travellers, real
time information
board’s cycle and
footpaths.
Businesses
and
organisations
in Solihull
Time-scale
Recommended
lines of Action
Recommended
Indicator for
success
On-going
Challenges in
Solihull
> 2 new travel plans
established in each
year.
On-going
Current status in
Solihull
All proposed public
transport
improvements are
delivered to
deadline.
Public
CENTRO
Travel West
Midlands
Solihull’s key strategic sites which include Birmingham International Airport [a Control of Major Accidents site due to the amount of fuel stored], the M42 corridor and the Land Rover plant [an A2 environmental permit site due scale rather than potential toxicity of any emissions produced]) are a significant influence on several areas being affected by noise pollution levels above 55 db(A). Defra Noise Mapping data highlights in particular the transect heading north‐west from Balsall Street (including Barston/Eastcote, Bickenhill, Marston Green, Chapelhouse and Castle Bromwich Hall), Monkspath/Hillfield (East) and Copt Heath, and Collector Road corridor (Castle Bromwich, Smith’s Wood, Bacons End and Chelmsley Wood East) – note that the industrial noise from Land Rover is contained within the area of the plant. There are other areas potentially affected by rail which include Olton, Ulverley Green, Hillfield, Dorridge and Marston Green. Note that Solihull only has one A1 site regulated by the Environment Agency which is the composting site on the boundary with Coventry, although there are a number of potential contaminated land sites, mainly where housing has been built on historic tips. There is potential to strengthen the impact of Public Health by working with the regional team of the Centre for Radiation Chemical and Environmental Hazards (CRCE) of the Health Protection Agency to ensure health representation on local Pollution and Contaminated Land groups. The local authority works closely with Birmingham International Airport to ensure that the effect of aircraft noise is mitigated as far as possible. It has already been noted that HS2 is likely to be a 199 significant issue over the coming decade; including construction noise in the first instance (the Yorkminster Drive area along the eastern edge of Chelmsley Wood is anticipated to be the most likely substantial affected area of housing within Solihull). Noise pollution is worse in areas of high density housing, rented accommodation, areas of deprivation and areas which are highly urbanised. This can increase stress and hypertension in adults and reduce educational attainment in children – both have adverse affects on mental health. Local evidence that supports the importance of taking a wider view of public health includes domestic noise regulatory activity, which generates upwards of 1000 complaints a year. Whilst anti social behaviour and/or substance misuse is often an element in the cause of these complaints, poor quality, high density housing with insufficient noise insulation between units contributes to the problem; most complaints come from the regeneration wards in North Solihull. As mentioned earlier, this is important because noise is known to cause stress and anxiety with measurable effects on physical and mental health (includes sleep disturbance, cardiovascular effects and damage to work or school performance – World Health Organisation 2012). Furthermore, there is a small but significant number of complaints where there is no external noise source. The complainants may be suffering from the physical effects of hearing damage or disease (which can lead to noise in itself as sufferers turn the volume up on TV’s), tinnitus (which may be exacerbated by prescriptions for other conditions) and other similar conditions. Environmental health officers in the authority are keen to enhance relationships with health professionals who come across the consequences of noise and/or people who are complaining of noise when it is actually a symptom of disease or other ill health. Prevention of Ill Health/Premature Mortality through Healthy Homes Neighbourhoods (integrate the planning, transport, housing, environmental and health services to address social determinants of health). Clustering of housing into relatively poor or relatively rich areas has increased over the past few decades – those features of a local area that encourage health (good schools, health services, employment opportunities and good housing) also tend to increase house prices. At the opposite end there is a ‘residualisation’ effect of social housing tenants with higher rates of unemployment, ill health and disability ‐ this feature of environmental association with health is perhaps more applicable to Solihull than the quality of housing (Decent Homes standards are good). Housing (targeting home improvements at low income households improves physical and emotional wellbeing). Increased housing density potentially leads to more people being exposed to weather extremes and flooding and cold housing is the main explanation for excess winter deaths – a third of the poorest quintile of houses in fuel poverty compared with less than 1% in the richest quintile (also affects people living with asthma and other breathing difficulties – English House Condition Survey, DCLG). Children in bad housing are also more likely to have mental health problems, slow physical growth and delayed cognitive development. The previous government through the Office of the Deputy Prime Minister in 2003 commissioned a study on the links between housing conditions and the health and safety of occupiers. The study identified 29 potential hazards which could be attributable to housing design and/or condition (this excludes hazards such as tobacco smoke that are attributable solely to occupier behaviour). Based on this work, initial estimates suggested that these hazards might be implicated in up to 50,000 200 deaths and 0.5 million injuries in England each year. The greatest number of deaths, over 40,000, was linked to problems of excess cold because of energy inefficiency. The evidence also suggests that accidents in the home result in more injuries than accidents at work or on the road. A seminal report in this subject entitled, The Real Cost of Poor Housing (BRE, 2010), applied mean Housing Health and Safety Rating System (HHSRS) scores to these factors – the report advises that the estimated cost of remedying category 1 hazards could average only £4,000 per home. The Environmental Protection Team within the Public Protection division of Solihull MBC is responsible for inspecting domestic properties that have been identified as being potentially unsafe. It is anticipated that there is considerable scope for joint working related to housing related activity through the integration of public health within the Local Authority. The following areas are thought to be of most importance. The Housing Act 2004 was designed to bring in a proactive, preventative way of looking at injuries in the home. The idea of risk assessing a home and taking actions to stop accidents or ill health from happening has been shown in many studies to be more cost effective than treating the injury or illness. The key to having a robust and effective injury prevention strategy is to make sure that those resources are targeted to where they can have the biggest effect. This inevitably requires an approach to commissioning that is intelligence driven from the outset and continually evaluates the cost effectiveness of subsequent outcomes. This also requires an end to end focus on services for patients that mandates partners working together to deliver real collective improvements. Forecasts from POPPI (Projecting Older People Population Information) suggest that falls for people in Solihull aged 65 and over are expected to increase by 48% from 10,236 in 2010 to 15,102 in 2030. The greatest increase is likely to be in those aged 85 and over who are predicted to have a fall (increasing from 21% of the total in 2010 to 30% in 2030). A significant number of people over the age of 65 live alone and this presents challenges to services in how best to support the needs of the individual especially if that person has expressed a wish to remain living at home. The expected increase in the numbers of people living alone also needs to be considered against the rise in the numbers of dispersed families meaning that for many, access to support from family members will not be available. Another example of an intervention to prevent injury might be if NHS data shows that children in Smith’s Wood are more likely than anywhere else in Solihull to fall from first floor windows; the Environmental Protection team could work with partner agencies (eg schools, children’s services etc.) to educate children and their parents about the dangers of first floor windows. It may even be feasible to use the HHSRS technique to target the most dangerous window designs (e.g. low window sills) and fit window restrictors. A closer relationship between the Local Authority, NHS and GPs could even include GPs making a referral or recommending an HHSRS inspection. For example if a patient presents with bronchitis and the GP learns that they live in a rented property with no heating, damp and mould, and a landlord who is refusing to help – Environmental Protection can ensure that the property is brought up to standard by requiring the landlord to install heating and ventilation. The biggest positive about modifying a property to make it safe, is that the changes are long term: once restrictors have been 201 put on the windows they will be in situ for many years even after a new family has moved into the property. The same is true of the lack of heating or domestic hygiene or uneven flooring. Public Protection have arrangements to train a number of partner agencies (adult and children’s social services, neighbourhoods teams, police, fire service, Age UK, CAB and SCH) to spot some of the more contributing factors in home based accidents. It should also be noted that Section 5 of the Housing Act 2004 states that “If a local authority consider that a category 1 hazard on any residential premises, they must take the appropriate enforcement action in relation to the hazard”. General Environmental Health/Prevention of Nuisance Although pest control is not a statutory duty it often indicates that wider problems such as rubbish accumulation and poor sanitation exist. The Environmental Health/Pest Control team of Public Protection are responsible for enforcing the provisions of the Prevention of Damage by Pests Act 1949, which requires landowners to take steps to keep their land clear from rats and mice. Pests such as rats and mice spread diseases and contribute to unhealthy living conditions, which is why the control of pests has been a fundamental part of public and environmental heath for the last 150 years. The control of pests needs a sustainable approach based not only on professional knowledge but also a good working knowledge of the local problem areas. The objective of the Team’s pest management programme is to reduce the conditions that encourage the presence of pests and allow infestations to thrive. In 2002, the World Health Organization carried out a major survey, known as the LARES survey, into the relationship between health and housing. This involved investigating the housing conditions of 8,400 inhabitants in 3,800 dwellings in eight European cities. The survey showed that 60% of premises had been infested by at least one pest in the previous year and that living in pest infested premises can seriously affect the health of residents. In particular, it showed that there is a clear association between pest infested premises and allergies and asthma. It also provided clear evidence that people are more likely to suffer from migraine, headaches and depression if they live in pest infested homes. Dwellings include houses, flats (self‐contained and non self contained), bedsits and rooms in halls of residence or similar residential buildings. The presence of pests in premises used as accommodation by people can lead to a considerable risk to public health. The risks posed by pests include: The spread of disease or pathogens are transferred from the gut or external surface of the pest 





Allergies Bites Psycho/social stresses Damage to property Contamination of work surfaces and foodstuffs Loss of income from tenants 
Prosecution and closure Changes to pest control service delivery have led to an increase in DIY treatments and the use of “over the counter” products. DIY pest control greatly increases the risk of problem areas being left untreated and where treatments are carried out, being carried out ineffectively. In some instances 202 the homeowner may cause a greater problem. Results from the LARES survey found that homeowners who treat their own homes for pests are : 



17% more likely to have allergies 27% more likely to suffer wheezing and breathing problems 30% more likely to suffer form inflamed eyes and sight problems 39% more likely to suffer from recurring headaches. To overcome these problems there needs to be greater public awareness of the potential health threats from pests and the correct ways to deal with them. Filthy and verminous premises There has been an increase in the number of requests for assistance in cases where occupiers of properties are unable to cope with daily life and as a result are considered to be a risk to both themselves and others. The Environmental Health and Pest Control Team are working with Adult Safeguarding, Age UK and SCH to assist in the provision of safe living conditions by arranging clearance and sanitisation of properties that have become filthy and verminous. This helps to keep people in their own home for longer provides a better quality of life. Preventing Ill Health through Animal Health Control Animal diseases can prove catastrophic for both the economy and if they are zoonotic they can cause serious ill health issues and potential death in humans (e.g. swine and avian flu, rabies etc.). With both European and national legislation in place to try to control such diseases, the Local Authority has an animal health function and associated duties that aim to prevent/control the spread of animal diseases in both human and animal populations. Disease emergence and spread do not respect geographical boundaries, and animals are often implicated as the source of human infection. Zoonotic disease management therefore requires an integrated approach that involves different sectors; mainly human, animal and food. Efficient early warning and forecasting of zoonotic disease trends through functional surveillance systems is key to effective containment and control. Early intervention during a disease epidemic often leads to better outcomes with reduced disease burden and associated economic impact Any disease or infection that is naturally transmissible from vertebrate animals to humans and vice‐
versa is classified as a zoonosis according to the PAHO publication "Zoonoses and communicable diseases common to man and animals". Over 200 zoonoses have been described and they have been known for many centuries. They are caused by all types of agents: bacteria, parasites, fungi, viruses and unconventional agents. Some examples of zoonoses, classified according to the type of causative agent, are: Bacteria Every year millions of people get sick because of foodborne zoonoses such as Salmonellosis and Campylobacteriosis which cause fever, diarrhoea, abdominal pain, malaise and nausea. Other bacterial zoonoses are anthrax, brucellosis, infection by verotoxigenic Escherichia coli, leptospirosis, plague, Q fever, shigellosis and tularaemia. Parasites Cysticercosis/Taeniasis is caused by a parasite which infects swine and can cause seizures, headache and many other symptoms in humans. In Latin America for example, 100 out of 203 100 000 inhabitants suffer from this disease (estimation). Other parasitic zoonoses are trematodosis, echinococcosis/hydatidosis, toxoplasmosis and trichinellosis. Viruses Rabies is a disease of carnivores and bats mainly transmissible to humans by bites. Almost all persons infected by rabid animals will die if not treated. An estimated number of 55 000 persons, mainly children, die of this disease in the world every year. Dogs are responsible for most human deaths. Other viral zoonoses are avian influenza, Crimean‐Congo haemorrhagic fever, Ebola and Rift Valley fever. Fungi Dermatophytoses are superficial mycoses that may be acquired from infected animals and affect the skin, hair and nails of humans, causing itching, redness, scaling and hair loss. Another mycotic infection that can be zoonotic is sporotrichosis. Unconventional Agents The agent of Bovine Spongiform Encephalopathy is thought to be the cause of variant Creutzfeldt‐Jakob Disease (vCJD) which is a degenerative neurological disease different from CJD, at present inevitably lethal in humans Zoonoses still represent significant public health threats, but many of them are neglected, i.e. they are not prioritized by health systems at national and international levels. However through Public Protection’s animal health function and its work with partner organisations the risks can be controlled. Trading Standards Trading Standards Officers are responsible for the enforcement of legislation around consumer product safety. Recent work in this area has included; the seizure of mothballs made from a banned carcinogenic substance, and subsequent Europe wide RAPEX alert; and, work towards the recall of wall mounted shower stools for people with mobility problems. Weights and measures legislation has traditionally related to that equipment in use for trade. In 2003 scales used for medical purposes were brought within the scope of the legislation. During May and June 2012 the Trading Standards service tested 235 scales used in doctor’s surgeries and found 31% were outside the tolerances permitted by the legislation. In each case a notice requiring correction within a specified period was served. Statute requires that commercial vehicles have a maximum gross weight in order to ensure that the brakes, steering etc. are capable of operating correctly. Trading Standards Officers regularly take part in multi‐agency vehicles checks, weighing vehicles in order to ensure they are not heavier than the statutory maximum. If a vehicle is found to be over loaded it can be prohibited from driving on the road, and the driver and operator prosecuted. The term doorstep crime covers a range of criminal activity including cold calling rogue traders. Home Office research suggests that only one in ten incidents of criminality are reported and of those, research (Thornton et al 2006) has found that 40% of victims reported that the incident had a significant impact on the quality of their life, 10% suffered with moderate to severe anxiety 3 months later and 23.3% suffered with probable depression 3 months later. Also, the effect of burglary on older people in sheltered accommodation is considerable, as 2 years after burglary, they 204 were 2.4 times more likely to have died or be in residential care than non‐burgled neighbours (Donaldson 2003). A range of products exist for which there is a statutory minimum age for the purchaser, referred to as age restricted products. Some restrictions such as those applied to spray paint and knives are intended to prevent disorder, whereas others, such as those applied to tobacco and alcohol, are intended to prevent harm to young people. Trading Standards Officers, with the assistance of underage volunteers, regularly carry out test purchase exercises in order to identify those traders willing to sell age restricted products to those under age. Exercises tend to concentrate on products such as alcohol, tobacco and fireworks; however intelligence is used to highlight emerging threats relating to other products. For example, in answer to an increase in knife crime in certain areas of the Midlands an exercise was carried out to assess compliance with the age restriction for knives. During the financial year 2011/12 a total of 58 test purchase attempts were made for alcohol, (on and off licences) fireworks and tobacco which resulted in 6 sales of tobacco and 2 of alcohol being made. Appropriate formal action was taken in respect of the contraventions. 205 HealthandWellBeingStrategyandthe
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Introduction ‐ Solihull Residents need a transport network which allows them to travel about the borough and neighbouring areas easily and affordably. Good transport links can improve access to health improving opportunities such as education, employment, leisure and healthcare. Over reliance on cars increases air and noise pollution, exacerbates parking issues and contributes to climate change. Road users are responsible for up to 70% of air pollution in urban areas. Overall residents of Solihull experience relatively low levels of living environment deprivation. The most deprived LSOAs from a living environment perspective are in the Lyndon and Elmdon wards and are subject to relatively poor local air quality. These wards also experience a relatively high rate of hospital admissions for asthma. Solihull is a broadly affluent borough. However, there are pockets of deprivation with 22 of the borough’s 133 Lower Super Output Areas (LSOAs) being in the 20% most deprived areas in the country. Solihull has seen an increase in the number of LSOAs in the most deprived 10% nationally (15 compared to 10 in 2007) and there are now two LSOAs in the bottom 5% compared to none in 2007. The impacts of this are felt across a broad range of outcomes including educational attainment, employment, crime and health. There has been a significant demographic change in Solihull. Since 1981 the proportion of residents aged 65 and over has increased from 11% to 19% and there are now 12,700 more residents aged 65 to 84 years and 4,100 more aged 85 years and over. This ageing population represents a significant and growing challenge in terms of health and social care. Without good transport networks, elderly people are at increased risk of loss of independence and social isolation. There were 115,662 cars or vans in Solihull in 2011, an average of 1.43 for every household in the borough, compared to the England average of 1.26 and the West Midlands average of 1.28. However, there is huge variation in vehicle ownership across the borough. In Dorridge and Hockley Heath, Blythe, Meriden and St Alphege, approximately 40% have access to 2 cars or vans. In contrast, in Chelmsley Wood, Kingshurst, Fordbridge and Smith’s Wood, 41% do not have access to even one car or van. The number of cars and vans has increased by 11% since 2001 and only 7.2% of working age Solihull residents either walk or cycle to work. Active Travel It is estimated that the obesity crisis will cost the UK £20 billion annually in lost productivity. In Solihull, over 29% of children in year 6 are overweight or obese. Encouraging sustainable use of transport to give good accessibility will promote a healthy population with less obesity and less pollution. Working jointly with public health has proven methods in getting more people active, Professor L Davies (President of the Faculty of Public Health) states that “the new delivery system for Public Health presents challenges but also opportunities for us all to be involved to have greater influence over the major determinants of health, among which transport and the built environment 206 are pre‐eminent”. Professor Davies also suggests that investing in people to become more physically active requires wise use of public money which will result in bigger savings in the long term. Encouraging more people to travel actively requires investment in proven behaviour change programmes such as the following: 
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Swap a car trip for an active trip (Sustrans project run in Exeter resulted in 18% increase in walking, 33% increase in cycling and 13% increase in public transport) Walking works project (Living Streets working with businesses resulted in an increase of staff walking from 35% to 49%. Cycling the school run (this Sustrans project worked with schools that had 70% of children never cycling to school. By the end of the project 44% of children were cycling to school at least once a week) Walking Buses (a walking bus funded by Solihull MBC has been a success on many fronts. The attendance and punctuality of the children has increased significantly with one child increasing from 66% attendance in the Autumn term to 100% attendance in the Spring term) Effective behaviour change projects such as the ones discussed above can only be achieved by working jointly with transport teams, public health and other relevant parties such as education departments. In the light of this, we are working jointly to improve active travel to school, with a particular focus on cycling to school and walking buses. Road Safety Road traffic accidents impose a range of impacts on people and organisations, including pain, grief and suffering, lost economic output, medical and healthcare costs, material damage, police costs, insurance administration, legal and court costs. The total cost for these collisions in Solihull is around £32 million of which approximately £1.9million is directly attributable to medical and ambulance costs. Road safety continues to be an important influence for Public Health and the future changes in the structure and delivery of Public Health may support improved integration across this field. Focusing on prevention is paramount to tackling road safety and this will be achieved by working closely with partners to deliver a range of interventions including:  To identify synergies as part of the review and integration of Public Health functions.  To develop stronger partnership working in this area through continued support for Solihull’s Area Road Safety Partnership.  Support the Local Authority in undertaking an annual review of collisions to identify trends and patterns to be addressed through implementing a programme of engineering, education and enforcement.  Support work targeting key vulnerable road users such as the elderly, children particularly those from deprived areas as well as the more vulnerable modes of transport such as cycling. Although Solihull has seen significant progress made in reducing casualties within the borough, there are some increasingly higher risk casualty areas. These include: 
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Transition to Secondary School (11‐14 year olds) often travelling independently for the first time. Young Drivers (17‐25 year olds) ‐ males are particularly at risk and a quarter of all men who die by the age of 25 are killed in road traffic collisions. Older people ‐ There is some evidence nationally of higher rates of pedestrian injuries among older people in disadvantaged areas but more analysis needs to be carried out to enable proper programme planning and intervention to understand and address. 207