Atherstone Place Based Needs Assessment

Warwickshire Joint Strategic Needs Assessment 2017

DOCUMENT INFORMATION

Document Name: Atherstone Place-based Needs Assessment Published Date: Tuesday, 07 November 2017 Version: 1.2 Release: Final Authors: Insight Service, Warwickshire County Council Owner: Rachel Robinson This document is only valid on the day it was printed.

The source of the document will be found at this location: https://apps.warwickshire.gov.uk/api/documents/WCCC-644-422

REVISION HISTORY

Revision Date Previous Revision Summary of Changes Change Marking 1-Mar-17 N/A Initial draft produced N/A Comments taken into account 30-Apr-17 0.1 from stakeholder group and 0.2 additional chapters Updated to circulate for 2-Jun-17 0.2 0.3 stakeholder event 30-Sep-17 0.3 Published and amended 1.1 7-Nov-17 1.1 Additions to include service data 1.2

DISTRIBUTION

This document has been distributed to:

Name Title Date of Issue Version Atherstone Stakeholder N/A N/A 0.1/0.2 Group Stakeholder event N/A 2-Jun-17 0.3 participants Atherstone Stakeholder N/A 30-Sep-17 1.1 Group Rachel Robinson Associate Director of Public Health 7-Nov-17 1.2

2 CONTENTS

Key Messages ...... 6

Demographics ...... 6 Health ...... 6 Education, Employment & Income ...... 7 Crime & Community Safety ...... 8 Road Safety & Transport ...... 9 Environment & Technology ...... 9 Social Care ...... 10

Recommendations ...... 10

Introduction ...... 11

Local Context ...... 12 North Warwickshire Borough Local Plan ...... 14

Demographics ...... 16

Current & Future Population ...... 16 Ethnicity ...... 19 Birth Rates ...... 20 Life Expectancy ...... 21 Deprivation ...... 23 Food Bank Users ...... 24 Mosaic Profile ...... 27 Households ...... 29

Health ...... 30

Smoking ...... 30 Alcohol Misuse ...... 32 Drug & Alcohol Treatment Services ...... 34 Obesity ...... 35 Hypertension ...... 36 Fitter Futures Service ...... 38 Diabetes ...... 40 Coronary Heart Disease ...... 41 Stroke ...... 42 NHS Health Checks ...... 43 Cancer ...... 44 Chronic Obstructive Pulmonary Disease (COPD) ...... 47

3 Dementia ...... 48 Emergency Hospital Admissions ...... 49 Mortality ...... 50 Maternal and Child Health ...... 53 Smoking in Pregnancy ...... 54 National Child Measurement Programme (NCMP) ...... 55 Teenage Pregnancy ...... 57 Breastfeeding ...... 59 Sexual Health ...... 60 Screening ...... 62 Mental Health ...... 62 Carers ...... 65

Social Care ...... 70

Priority Families Programme ...... 70 Children’s Social Care ...... 72 Adult Social Care ...... 75

Education, Employment & Income ...... 79

Education ...... 79 Education, Skills and Training Deprivation ...... 87 Employment & the Economy ...... 89

Crime & Community Safety ...... 98

Road Safety & Transport ...... 104

Road Casualties ...... 104 Access to a car or van ...... 106 Congestion ...... 106 Access and Public Transport ...... 107

Environment & Technology ...... 109

Fuel Poverty ...... 109 Flooding ...... 110 Waste ...... 110 Air Quality ...... 113 Green Spaces ...... 113 Technology ...... 114

Services ...... 116

Interdisciplinary Hubs ...... 117

4 Warwickshire North Local Estates Forum ...... 119 Atherstone Masterplan ...... 119 Warwickshire Community and Voluntary Action ...... 120 Volunteer Centre ...... 123 Councillor Grants & Funded Projects ...... 123

5 KEY MESSAGES

DEMOGRAPHICS

• Compared to the national average Atherstone, like North Warwickshire Borough as a whole, has a relatively higher proportion of its population in the 40-69 and 70+ age groups. Conversely, it has a relatively smaller 0-15 and 16-39 population. • North Warwickshire’s population has remained fairly static for a number of years, with a limited growth in the birth rate and limited migration into the area. This trend is likely to continue into the future based on the projections available for the Borough. • Where the population is growing, it is in the older age groups. This has an effect on the dependency ratio i.e. the number of working age residents who support those who are dependent (the old and young). Increasing numbers of older people, like elsewhere in Warwickshire, are likely to continue to influence and shape the future provision of all services. While there may be higher costs in some of these areas relating to health and social care needs, there may also be economic and social opportunities created in others. • While the demands on services relating to children and young people are likely to remain fairly static or reduce in the short term, there may be localised pockets of demand, for example, in childcare and school places, where declining numbers have not been so marked. For other services, predicting need on the basis of population alone is more complex and is subject to other factors such as levels of deprivation in an area. • Atherstone and North Warwickshire Borough are much less ethnically diverse than the Warwickshire average, with high proportions of those who consider themselves to be ‘White British.’ • Just under 8% of households in Atherstone Central are classed as being deprived in either three or four specific areas of the index. • Atherstone Central (Central) Lower Super Output Area (LSOA) records a rate of single household occupancy of 45%, compared to a North Warwickshire Borough average of 26%. • Life expectancy levels are lower across Atherstone than the county averages. At ward level, Atherstone Central has the lowest life expectancy at birth for males at 75.0 years in Warwickshire, compared to a county figure of 79.9 years.

HEALTH

• There are both positive and negative factors to be taken into consideration in the health findings of Atherstone residents. Screening uptake for bowel, breast and colon cancer are significantly better than the England rates. The prevalence and control of diabetes is similar to national figures. Additionally, there are no significant differences in infant mortality or low birth weight babies when compared to national data. • However, there are some areas which need further attention. The mortality data points to a significant cardiovascular disease and lung cancer burden. The mortality rate due to coronary heart disease in those aged under 75 is 67% greater than expected, whilst the

6 mortality rate due to all causes in those aged under 65 is 30% greater than expected. These rates represent historical exposure to risk factors, but whilst diabetes control appears to be in line with other areas, the prevalence in both surgeries and management of hypertension in patients registered at The Atherstone Surgery is problematic. • It is difficult to comment on the success of smoking cessation efforts locally, but the mortality data combined with high rates of chronic obstructive pulmonary disease (COPD) suggest that smoking cessation efforts in the area need further exploration and support. The proportion of patients registered at Station Street Surgery that are smokers is particularly high at 24.8%. Interestingly, the current rates of coronary heart disease and stroke are not significantly different to England or Warwickshire North Clinical Commissioning Group (CCG). • Mental health is a recognised priority for this area. Atherstone Middle Super Output Area (MSOA) has 52% more hospital admissions for self-harm than expected, with Atherstone Central the most affected ward. There is a higher rate of suicide in Warwickshire as a whole compared to England and other similar areas. A new suicide prevention strategy is being rolled out and it is important that service providers in Atherstone are supported to take advantage of this. • There have been some improvements in sexual and reproductive health with year-on-year decreases in the proportion of mothers who smoke during pregnancy. However, rates in Warwickshire North CCG are still higher than national equivalents. There have also been overall falls in the number of teenage conceptions. However, Atherstone Central ward has significantly higher numbers of teenage pregnancies compared to other wards in North Warwickshire Borough. Breastfeeding rates are significantly lower in the Borough compared to national figures. Chlamydia screening uptake remains significantly lower than national figures. These are complex issues and addressing them is likely to revolve around similar factors to the mental health and wellbeing needs of this population. • Children in Atherstone are more likely to have excess weight and be obese compared to other areas. This is more marked in reception aged children. The rate of increase in reception aged children is higher in Atherstone than elsewhere. Those who are obese in childhood are more likely to be obese in adulthood and suffer the associated negative health consequences. • The prevalence of increasing and higher risk alcohol consumption in North Warwickshire Borough is the same as England and Warwickshire. This is approximately one in five adults; still an area of concern.

EDUCATION, EMPLOYMENT & INCOME

• In 2016, in Atherstone the gap between those children who are disadvantaged and those who are not in terms of school readiness is slightly greater than North Warwickshire Borough as a whole (36%, compared to a Borough average of 33%), and considerably more than the Warwickshire equivalent (21%) and national average (18%). Atherstone South & Mancetter ward has the largest gap at 45%. • There are higher proportions of children attending schools in Atherstone who are eligible for free school meals (FSM) than North Warwickshire Borough and Warwickshire.

7 • There has been a large increase in the number of apprenticeships in Atherstone over the past five years. This has risen from seven apprenticeships in 2012/13 across the three wards to 34 in 2016/17. • The number of people claiming worklessness benefits has reduced over the past five years, with the largest reduction in the number of claimants seen in both Atherstone Central ward (21%) and Atherstone South & Mancetter ward (21%). It should be noted that at this stage, it is hard to differentiate if this is a true fall in benefit claimants or a result of some claimants moving to Universal Credit. • The rates of disability living allowance claimants (per 100,000 0-65 aged population) in the three wards in Atherstone are considerably higher than the equivalent Warwickshire rate. The highest rates have been seen consistently in Atherstone North ward. • Citizens Advice Bureau North Warwickshire provide advice to members of the community on a range of issues. In the three Atherstone wards, the main area of concern for residents in relation to debt advice has been council tax arrears. The second highest debt concern issue for residents of these three areas was rent arrears. Interestingly, Atherstone North ward residents were most concerned about fuel debts. • The highest number of advisory sessions held by Citizens Advice Bureau North Warwickshire was for benefit advice. In the period April 2016 to March 2017, 600 advisory sessions were held for residents of the three Atherstone wards. The benefit that residents were seeking the most advice on was Employment Support Allowance (83 sessions). This differs for residents of Atherstone Central ward where the benefit issue of most concern to them was ‘housing benefit’.

CRIME & COMMUNITY SAFETY

• Atherstone Central Ward has the highest crime and anti-social behaviour (ASB) rate per 1,000 population of the three Atherstone wards and all three wards have a crime rate above the borough and county average. • Atherstone South & Mancetter was the only ward to see an increase in ASB levels. The ward also has a relatively high proportion of ‘personal’ ASB incidents. • Shoplifting is the highest volume crime type in Atherstone Central ward. Previous initiatives to tackle this have had limited success but new initiatives which have had results elsewhere in the county are now being trialled. • The proportion of alcohol/drug related offences was highest in Atherstone South & Mancetter ward and for all three wards assault related offences were most likely to be related to alcohol and/or drugs. • Because of the relatively low levels of crime, single incidents that result in multiple victims (and are therefore recorded as multiple offences) can cause a spike in the recorded crime levels. It is also the case that one prolific offender carrying out multiple offences can have the same effect. • Offender data reveals that those aged between 20-29 are the most likely to be victim of violent crime whereas the over 60’s are more likely to become a victim of domestic burglary or theft offences.

8 • Although there are only a small number of female offenders, two individuals were responsible for 10 offences each during the examined period which is the highest number for any individual offender.

ROAD SAFETY & TRANSPORT

• There has been an increase in road casualties over the past four years in the three Atherstone wards. In 2015 there were 24 road casualties recorded, where 79% of casualties received ‘slight’ injuries, 21% received ‘serious’ injuries and no fatalities were recorded. • Wet and damp weather can be a contributory factor to road traffic collisions in Atherstone where almost one third of road casualties (29%) had an accident which occurred on a ‘wet/damp’ day but the majority of accidents occurred in fine dry weather. • Mondays saw the highest level of road casualties recorded, with 23% of accidents. The highest proportion of accidents occur between 13:00 and 18:00 across the three Atherstone wards (59%). • The roads in Atherstone which recorded the highest level of road casualties were A roads, typically around the A5. Over one third (39%) of road casualty victims recorded their accident as being on this type of road. • Across the three Atherstone wards the main area of congestion is in Atherstone Central ward in the town area, where between the peak morning times of 08:00 to 09:00 speeds are approximately 0 – 5 miles per hour. • Just less than 30% of households in Atherstone Central ward do not have access to a car or van.

ENVIRONMENT & TECHNOLOGY

• The latest fuel poverty data shows that the most fuel poor area in Atherstone is Atherstone Central - Centre LSOA, where 12.4% of households are considered to be fuel poor. • In 2016 in Warwickshire, only 9% of people aged over 16 said they had either never used the internet or used it over three months ago compared to 19.8% in 2011. • Older people and those who self-assess that they have a disability (in line with the Equality Act definition of disability) are the least likely to use the internet. • Mosaic (a customer insight tool) can be used to identify communication channel preferences and how likely residents may be to adopt technology. The mixed age profile of Atherstone means that there are a variety of different communication preferences and attitudes to technology in the Mosaic Groups most represented in Atherstone and the need for a blended approach should be taken into account when considering any communication with residents in this area. • Of the top five Mosaic groups identified in Atherstone, none of these feature in the top three groups most likely to adopt technology (i.e. they are not considered to be ‘innovators’) or in the top four Mosaic Groups in terms of owning a smartphone or internet usage.

9 SOCIAL CARE

• There is considerable difference in the service user profile for Adult Social Care users in Atherstone when compared to Warwickshire, with more people accessing community services and less accessing low level and preventative services. • In Atherstone, the largest proportion of clients face issues with a physical long term health condition for which they seek support from social care services. • There was a 5.5% reduction in the number of children subject to a Child Protection Plan in the combined three Atherstone wards which is in line with the reduction seen across the county (6.3%). However, there is variation when we focus down at ward level, with Atherstone North ward experiencing an increase. • Generally Atherstone children appear to spend longer on a child protection plan compared to Warwickshire children. In Atherstone there are a higher proportion of children that have been on a Child Protection Plan for 1 to 2 years (32%), compared to the proportion of Warwickshire children (19%). • In Atherstone, bearing in mind low numbers and large percentage increases, there has been a 93.9% increase in the number of children subject to ‘Child in Need’ where figures almost doubled when comparing 2013/14 (66) to the corresponding period of 2015/16 (128).

RECOMMENDATIONS

Recommendations are included within a separate document, developed from the initial stakeholder event along with a detailed action plan and extensive stakeholder feedback.

10 INTRODUCTION

A needs assessment is a systematic method for reviewing the health and wellbeing issues facing a population, leading to agreed priorities and resource allocation that will improve health and wellbeing and reduce inequalities.

This work falls under the remit of the Joint Strategic Needs Assessment (JSNA) and supports the place-based programme of work that the JSNA is undertaking, that is, insight about the needs of people in a certain geographical area rather than the needs of people with a certain condition (for example, dementia) or theme (for example, children looked after).

Broadly speaking, the needs assessment is split into three important elements: • Need – claim for a service and the ability to benefit. • Supply (or services) – what services are currently provided and by who? • Demand – who is making use of services (including both over (inappropriate) and under use)? These areas all overlap to a degree and are influenced by each other (Figure 1). Figure 1: Need, demand and supply: influences and overlaps

11 The determinants of health are depicted in the model by Dahlgren and Whitehead (Figure 2). The model highlights that it is not only genetics and lifestyle choices, such as smoking and diet, that influence a person’s health but that there are wider socio-economic factors, such as networks of friends and family, opportunities to education and employment, housing, public transport, and access to amenities, which contribute to overall health and wellbeing.

Figure 2: A Social Model of Health (Dahlgren and Whitehead)

The purpose of this needs assessment is to:

• Identify the health and wellbeing needs of the population of Atherstone; • Map the services available in Atherstone; • Make recommendations for how services can be improved / redesigned to make sure they are being delivered to the people who need them most.

This report was commissioned by a partnership group working across Atherstone and is being delivered by a small steering group which consists of North Warwickshire Borough representatives, community development workers, a public health consultant, localities and partnerships officers and an intelligence analyst.

LOCAL CONTEXT

For the purpose of this needs assessment, the focus of the analysis and recommendations are the three wards that cover the town of Atherstone: Atherstone North, Atherstone Central and Atherstone South & Mancetter. These are shown in Figure 3 where it can also be seen that Atherstone South & Mancetter ward includes part of the rural area to the south of the town. As

12 there are relatively few properties in this area much of the data used will not be distorted through its inclusion. Figure 3: Map of Atherstone area covered in this needs assessment

© Crown Copyright and database right 2017. Ordnance Survey 100019520.

The borough of North Warwickshire Borough is largely rural in nature and lies between the cities and towns of Birmingham, Solihull, Tamworth, Coventry, Nuneaton and Hinckley. Within the borough there are a number of settlements with the largest being the town of Atherstone. Other larger settlements include Coleshill, Polesworth/Dordon. In total there are 33 parishes in the borough.

13 The borough once had several coal mines but since these closed the economic focus has shifted to employment land. Companies based in the area include BMW, Aldi, TNT, 3M, Sainsbury’s and Ocado. The majority of companies however are small with 10 or fewer employees.

Settlements in the borough are well connected, both locally and nationally, through a network of road and rail links. Capacity on some of these roads is an issue as developments adjacent to them will lead to an increase in traffic flows. In addition to the Trent Valley line/West Coast mainline and the Cross Country railway lines, the proposed route of HS2 also passes through the borough. This will impact on businesses and residents as it is anticipated that there will be increased traffic in areas close to the route and some properties may be lost.

In addition to Warwickshire County Council and North Warwickshire Borough Council, Atherstone Town Council also provides some services to the town. These include the management of allotments, play areas and cemeteries, provision and operation of CCTV (in partnership with the Borough Council) and provision of grants to the local community. It has also produced a Community Emergency Plan for Atherstone and acts as a statutory consultee to the Borough Council for planning applications that affect the town. The Town Council has 15 Councillors and a Mayor is elected on an annual basis.

NORTH WARWICKSHIRE BOROUGH LOCAL PLAN

A Local Plan is being drafted for the borough, the purpose of which is to guide the sustainable development and use of land through to 2031 (Figure 4). However, it is also recognised in the Plan that growth will continue beyond this time frame and the borough council will work with partners and stakeholders to explore this.

Figure 4: Strategic objectives in the Draft Local Plan To secure a sustainable pattern of development reflecting the rural character of the Borough To provide for the housing needs of the Borough To develop and grow the local economy for the benefit of local residents To maintain and improve the vitality of the Market Towns To promote rural diversification To deliver high quality developments based on sustainable and inclusive designs To protect and enhance the quality of the natural environment and conserve and enhance the historic environment across the Borough To establish and maintain a network of accessible good quality Green Infrastructure, open spaces, sports and recreational facilities To ensure the satisfactory provision of social and cultural facilities

Proposed housing and employment sites

The Local Plan states that all development will take place within the boundaries shown on the maps that accompany the Plan; the map for Atherstone is shown below with proposed housing sites shown in pink and employment sites in blue (Figure 5).

14 The amount of additional housing needed has to be identified in the Plan. This not only has to take account of the needs of the Borough but the needs of neighbouring authorities as well. More detail on the amount and type of housing is included in the Strategic Housing Market Assessment for the five districts and boroughs in Warwickshire, this was originally produced in November 2013 and has subsequently been updated. From these figures, the number of additional dwellings needed in North Warwickshire Borough to the year 2031 has been identified, which will consist of a mixture of types and tenure, including provision for older people and people with mobility problems. Four sites identified in Atherstone for additional housing and the proposed number of dwellings are shown in Figure 6.

Figure 5: Land allocated for housing and employment in Atherstone

Updated to include 2017 Employment & Housing Allocation sites, © Crown Copyright and database right 2017. Ordnance Survey 100019520.

Figure 6: Sites allocated for housing Site Hectares Number Land at Holly Lane 32.7 531 Land to north-west of Atherstone off Whittington Lane 71.2 1,282 Land off Sheepy Road (football ground) 2.2 46 Britannia Mill redevelopment site, Coleshill Rd 0.4 54

15 The Local Plan also identifies a total of 8.2 hectares of land for employment land, 6.6 hectares of which has been allocated for further expansion of the Aldi depot. If they decide it is not needed it will be retained for employment, specifically mixed B1 (business) and B2 (general industrial) use.

DEMOGRAPHICS

CURRENT & FUTURE POPULATION

Figure 7 shows the mid-2015 population estimates for Atherstone, North Warwickshire Borough and Warwickshire. The population covering the three Atherstone wards is just under 11,300 people. The population pyramid compares the age distribution of Atherstone with the national average. Compared to England, Atherstone, like North Warwickshire Borough as a whole, has a relatively higher proportion of its population in the 40-69 and 70+ age groups. Conversely, it has a relatively smaller 0-15 and 16-39 population.

Figure 7: Mid-2015 population estimates for Atherstone Total Female Male Count Count % Count % Atherstone Central 4,150 2,064 49.7 2,086 50.3 Atherstone North 3,437 1,760 51.2 1,677 48.8 Atherstone South & Mancetter 3,679 1,841 50.0 1,838 50.0 Atherstone (total) 11,266 5,665 50.3 5,601 49.7 North Warwickshire Borough 62,787 31,810 50.7 30,977 49.3 Warwickshire 554,002 280,472 50.6 273,530 49.4

England - Females 85+ England - Males Atherstone - Females 70-84

55-69

40-54

25-39

16-24

Under 16

15% 10% 5% % 5% 10% 15% Source: Office for National Statistics, 2015

16

The population in North Warwickshire Borough has remained fairly static for a number of years. This trend is likely to continue into the future based on the population projections available for the Borough.

In 2016, the practice population of The Atherstone Surgery was around five times the size of Station Street Surgery; 15,410 and 3,206 respectively (PHE). The population distribution of the two GP surgeries in Atherstone is shown in Figure 8. Overall, there are more males than females across both surgeries. Although, the same basic age distribution is seen in both surgeries, there are proportionally more young people under the age of 15 and more adults over the age of 60 at The Atherstone Surgery. There are proportionally more people between the ages of 15 and 59 at Station Street Surgery. This difference is more marked in men and particularly between the ages of 45 and 59.

Figure 8: Atherstone Surgery & Station Street population profile

95+ 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

6% 4% 2% % 2% 4% 6%

WN CCG Females WN CCG Males Atherstone Surgery Females Atherstone Surgery Males Station Street Females Station Street Males

Source: Public Health England (PHE) Fingertips, 2016

17

North Warwickshire Borough’s population is projected to be more heavily influenced by migration than natural change (births-deaths) into the future and particularly in later years of the projection, internal migration (between local authorities) plays a larger role in influencing the figures (Figure 9). Between 2014 and 2039 in North Warwickshire Borough, the projected number of births remains constant each year and the number of deaths rises during the same period, resulting in negative natural change figures. Figure 9: North Warwickshire Borough Projected Population change, 2015-2039

Projected Population Change 2015 2039 (2014-based subnational population projections) Population 62,500 66,200 Natural Change (Births – Deaths) of which: -100 -200 Births 600 600 Deaths 700 800 All Net Migration* of which: 100 400 Internal migration In 2,900 3,200 Internal migration Out 2,900 2,900 *Other types of migration include International Migration and Cross-border Migration although this has no effect in North Warwickshire Borough. Figures may not sum due to rounding.

North Warwickshire Borough has low projected growth rates according to the 2014-based subnational population projections. Between 2014 and 2039, the borough population is projected to grow by 3,700 people or 5.9%. However, the rate of growth increases with age, with the eldest age group (85+) projected to increase by 180% from 2014 to 2039. Conversely, the 0-14 age group is projected to fall by 1% between 2014 and 2039. Figure 10 also highlights a static and falling working age population (15-64 years) in North Warwickshire Borough over time. The projected fall in the younger age groups particularly is not a trend seen witnessed across the other districts and boroughs in Warwickshire to the same extent and is likely to result in further under-representation in these age groups going forward.

The above has an impact on dependency ratios i.e. the proportion of the population who are dependent (those aged 0 -14 years and 65+ years) relative to the working age population. North Warwickshire Borough’s dependency ratio is projected to increase by 24 percentage points to 0.82 by 2039. Effectively this means there are 8.2 dependents for every ten people of working age. As the dependent population grows, this is likely to have implications for future service delivery.

18 Figure 10: Population change in North Warwickshire Borough by age, 1991-2039

Source: Subnational population projections, Office for National Statistics

ETHNICITY

Parts of Warwickshire are relatively diverse in terms of their ethnic profile, however, North Warwickshire Borough is much less diverse in comparison (Figure 11). The charts show that Atherstone Central is, relatively, the most diverse ward in Atherstone, with 97.6% of the population from a ‘White’ ethnicity, compared to the 98.5%, 98.0% and 97.9% in Atherstone North ward, Atherstone South & Mancetter ward and North Warwickshire Borough, respectively.

Of the ethnic minority groups, Asian/Asian British is the most common in Atherstone Central (1.4%) and Atherstone North (0.7%) wards, followed by those of a mixed/multiple ethnicity (0.8% and 0.4%, respectively). However in Atherstone South & Mancetter ward, mixed/multiple ethnic groups are highest (0.9%), followed by Asian/Asian British (0.8%). However, the proportions of all ethnic groups except ‘White’ is much lower than the Warwickshire figures and significantly lower than the national proportions.

19 Figure 11: Ethnicity profile, 2011 Census

Atherstone Central

Atherstone North

Atherstone South and Mancetter

North Warwickshire

Warwickshire

0% 20% 40% 60% 80% 100% White Mixed/multiple ethnic groups Asian/Asian British Black/African/Caribbean/Black British Other ethnic group

Atherstone Central

Atherstone North

Atherstone South and Mancetter

North Warwickshire

Warwickshire

86% 88% 90% 92% 94% 96% 98% 100% Source: Census 2011

In North Warwickshire Borough in 2011, 3.9% of the population were recorded as being born outside of the UK - a slight increase on the figure of 2.3% in 2001 but well below the county average of 8.3%. The most prevalent non-UK country of birth in North Warwickshire Borough is Ireland followed by Poland. The second most widely spoken language after English (spoken by 98.9% of the population) is Polish.

BIRTH RATES

North Warwickshire Borough has one of the lowest crude birth rates in the county, linking to the population analysis above. The crude birth rate for 2011 to 2015 was 10.4 births per 1,000 populations in North Warwickshire Borough. Stratford-on-Avon District was the only district in Warwickshire that had a lower birth rate (9.1 births per 1,000 populations) and a number of areas are considerably lower than the national benchmark (12.5 births per 1,000 population).

However, there is some important variation in crude birth rates at ward level and over time as can be seen in Figure 12. The 2015 crude birth rates for Atherstone Central ward (17.3 births per 1,000 population) and Atherstone North ward (12.8 births per 1,000 population) are higher than the

20 equivalent borough (10.6), county (11.0) and national (12.1) averages. Atherstone Central ward has consistently remained above the equivalent national and borough rates between 2011 and 2015 and Atherstone North ward birth rates shows a steady increasing trend over the same period.

Figure 12: Crude birth rates by ward, 2011-2015 25.0 Atherstone Central Atherstone North Atherstone South and Mancetter North Warwickshire Warwickshire England 20.0

15.0

10.0

5.0 Crude brith rate (per 1,000 live population) live 1,000 (per rate brith Crude

0.0 2011 2012 2013 2014 2015

Source: Office for National Statistics

LIFE EXPECTANCY

Life expectancy at birth

Life expectancy at birth has been used as a measure of the health status of the population of England and Wales since the 1840s. Period life expectancy at a given age for an area is the average number of years a person would live, if he or she experienced the particular area’s age-specific mortality rates for that time period throughout his or her life.

Life expectancy for both males and females has been increasingly steadily over the last few decades, primarily due to improvements in medical interventions, a decline in smoking prevalence, improved diet and healthier lifestyles, all of which have led to better survival rates.

Lower life expectancy is generally more prevalent in the north of the county than the south which is consistent with the pattern of deprivation and health inequalities across the county. Life expectancy at ward level for males ranges from 75.0 years (Atherstone Central, North Warwickshire Borough Borough) to 84.6 years (Snitterfield, Stratford-on-Avon District), and for females ranges from 79.2 years (Hartshill, North Warwickshire Borough Borough) to 91.5 years (Myton & Heathcote, Warwick District).

21 Life expectancy at birth is higher in females than males in all three wards in Atherstone. This trend is also seen at county, district and Warwickshire North CCG level. The largest gap between the figures for the two genders in Atherstone is seen in Atherstone Central ward, with a gap of 9.3 years (Figures 13 & 14).

Ward-level data is available over time and shows a slightly different picture for each ward and by sex. Atherstone Central ward’s life expectancy for males and females increased from 1999-2003 to 2008-2012 and has since stayed at broadly similar levels. Atherstone North ward stayed fairly stable between 1999-2003 and 2008-2012 and increased slightly for males in the 2010-2014 period. Atherstone South and Mancetter rose between the first two time periods but decreased for males and females in the 2010-2014 period.

Figure 13: Life expectancy at birth, by ward, 1999-2003 to 2010-2014

1999-2003 2008-2012 2010-2014 Wards Males Females Males Females Males Females Atherstone Central 71.6 78.6 75.0 84.1 75.0 84.3

Atherstone North 75.5 81.7 74.7 81.2 77.3 81.1

Atherstone South & Mancetter 77.2 81.8 79.2 85.4 77.7 84.1 Source: Local Health, Public Health England

Figure 14: Life expectancy at birth, by ward, 2010-2014

86 Males Females 84 England Females 82

80 England Males 78

76

74

72

70 Atherstone North Atherstone Central Atherstone South and North Warwickshire Warwickshire Mancetter Source: Local Health, Public Health England

Health outcomes have been shown to vary markedly between people depending on their socio- economic position based on occupation. Socio-economic position is a good indicator of general living conditions, access to goods and services, career development prospects, educational attainment, salary range, disposable income, wealth, assets and social standing. Such factors are important drivers of wellbeing and health.

22

These differences can be described as the health gap or inequality and can be compared between classes in the same geographical location, both between areas and between men and women.

Nationally, the health gaps are generally bigger for women than men. Yet the range of 'health gap' rankings is larger amongst men in the county than women (Figure 15). The districts/boroughs in Warwickshire are spread out from 84th place in Rugby to 283rd in Warwick (out of 346 local authorities in England, where 1 represents the smallest 'health gap') a difference of 199 places. Yet for women, Stratford-on-Avon has the lowest ranking in 118th place and Warwick has the highest in 247th, a difference of 129 places.

Figure 15: Health Gap for men and women (Slope Index of Inequality)

Source: Office for National Statistics (based on 2011 Census data)

DEPRIVATION

The 2015 indices of deprivation measure relative deprivation in small areas (Lower Super Output Areas -LSOAs). The most commonly used of the indices is the Index of Multiple Deprivation (IMD), which incorporates all of the individual indices to provide an indication of overall deprivation levels in an area.

The deprivation scores are ranked and split into deciles to allow comparison across all areas (LSOAs) nationally and to identify those areas in the top 10%, 20% and 30% most deprived nationally.

The 2015 update of the IMD shows that Mancetter South & Ridge Lane LSOA is in the top 10% most deprived areas nationally. Atherstone Central – Centre is in the top 20% most deprived areas nationally and Atherstone North – St. Georges and Carlyon LSOA is in the top 30% most deprived areas in the country (Figure 16).

23 Just less than 8% of households in Atherstone Central are classed as being deprived in either three or four specific areas of the index.

Part of a previous JSNA Needs Assessment (Loneliness & Social Isolation) suggests that Atherstone Central ward is a hotspot in terms of ex-service personnel at risk of deprivation, loneliness and social isolation. This will help inform future targeted activity under the banner of the Armed Forces Community Covenant.

Figure 16: Deprivation in Atherstone, 2015

Source: Department of Communities and Local Government, © Crown Copyright and database right 2017. Ordnance Survey 100019520

FOOD BANK USERS

Data was provided on 123 individual users of emergency food parcels living in Atherstone for November 2015 to the end of January 2017. There were 237 emergency food parcels requested in this 15 month period, 198 in the 12 months from February 2016 to end of January 2017 (Figure 17). Of the 237, 92 (39%) emergency food parcels were awarded for one week, 79 for 2 weeks (33%), 50 for 3 weeks (21%) and 14 for 4 or more weeks (6%).

24 Figure 17: Number of emergency parcels in Atherstone, from February 2016 to January 2017 25

20

15

10

5

0

Two in three (66%) users requested emergency parcels once during the 15 month period with a further 13% requesting the parcels twice. A minority (3.3%) requested parcels more than five times, with one individual requesting 16 parcels. There were numerous reasons for requesting emergency food parcels, often with more than one reason given for each request. The way the data is collected did not allow further analysis but the most common reasons given were benefit delay, debt, low income and rent arrears.

There were 13 streets/roads where there were requests for food parcels from more than two individuals (Figure 18). Of the 123 individuals requesting food parcels: • 62 (50%) were council tenants • 31 (32%) private tenants • 19 (15%) housing association tenants and • 2 (3%) were owner occupiers.

Six of the 123 individuals (5%) had also made an application for emergency fuel to Warwickshire County Council.

25 Figure 18: Atherstone addresses with high number of users of emergency food parcels Address Number of individuals Emergency parcels Friary Road 9 26 Long Street 9 18 Westwood Crescent 6 16 Meadow Street 6 7 Tannery Close 6 6 Welcome Street 5 13 Kings Avenue 5 9 Grove Road 5 6 Royal Meadow Drive 5 6 Bank Road 3 7 Stratford Avenue 3 7 North Street 3 6 Erdington Road 3 6 Source: Foodbank data, North Warwickshire

Of the individuals using emergency food parcels, 71 had no children under 16. The other families between them had 99 children – 26 had one child, 16 had two children, three had three children, three had four children and four had five children. Users were more likely to have children in the 5- 15 age group. There were at least 178 adults living in households where food parcels were requested (for some households, numbers of adults was not recorded so this number is likely to be higher). Of these the majority (61%) were households where only one adult lived with 32% of households having two adults and 7% more than two adults.

Figure 19 shows the community users from the Atherstone and Mancetter area using food supplied by food banks. This highlights the community groups utilising food produce to support the sustainability of their group and the figures highlight the weights (in kilos) each group in the area has had each month. This usefully shows how much the wider community (as well as those having emergency parcels) are benefiting from the food operation.

Figure 19: Weight of food supplied to community groups, April 2016 – February 2017 Community Group Total weight (kilos) Mancetter Community Group 1,408 TQEA 1,015 Volunteer Centre Long St. 854 NWCAB (Bridgette Chandler) 525 Race Meadow Primary Academy 481 Lions Club of Coventry 49 Mancetter Hub 45 Total weights 4,377

26 MOSAIC PROFILE

Mosaic is a profiling tool which uses a wide range of data to allocate households into similar groups and types based on likely common characteristics. Mosaic can help identify different needs that household groups and types may have, identifying where specific needs are located and understand each group’s preferred communication channels. There are 15 Mosaic Groups as outlined below:

Figure 20 shows the Mosaic profile of Atherstone, highlighting the proportions of each Mosaic Group in each ward and for the three wards in total, compared to the borough and county equivalents.

Each of the individual wards has a slightly different Mosaic profile. However, the majority of Mosaic Groups are represented in each ward. This indicates that services need to able to support both the elderly population, as well as young families, and people on a range of incomes.

Two in five residents in Atherstone Central ward are from Group L, ‘Transient Renters’ or Group K, ‘Modest Traditions’. Both of these groups are over-represented when compared with the county profile. Both of these groups are more likely to have a low/modest income and as a result will live in low cost/affordable housing.

Atherstone North ward has high proportions of Groups F, ‘Senior Security’ and B, ‘Prestige Positions’ who are generally expected to be older (aged 60 years and over). Over 15% of the ward’s population are from ‘Modest Traditions’ and are more likely to be homeowners living in the suburbs, on modest incomes in affordable housing. An index value above 100 means that the Mosaic Group is more likely than ‘average’ to be represented in this ward when compared to the overall Warwickshire population. This Group (Modest Traditions) is over two and half times more likely to live in Atherstone North ward when compared to the Warwickshire profile.

27 Figure 20: Atherstone Mosaic profile, % in each group Atherstone Atherstone All North Atherstone South & Mosaic Group Central Atherstone Warwickshire Warwickshire North ward Mancetter ward wards Borough ward A Country Living 0.0% 0.1% 3.3% 1.1% 12.3% 10.6% B Prestige Positions 0.3% 11.4% 8.2% 6.2% 5.0% 9.7% C City Prosperity 0.0% 0.0% 0.0% 0.0% 0.0% 0.8% D Domestic Success 0.1% 11.5% 5.0% 5.2% 5.7% 8.5% E Suburban Stability 4.7% 10.0% 13.5% 9.1% 13.9% 9.8% F Senior Security 2.8% 13.5% 14.1% 9.6% 9.1% 9.9% G Rural Reality 0.7% 2.6% 11.4% 4.6% 14.5% 7.1% H Aspiring Homemakers 10.5% 11.2% 8.2% 10.0% 11.0% 10.7% I Urban Cohesion 0.0% 0.0% 0.0% 0.0% 0.0% 1.7% J Rental Hubs 9.5% 0.1% 0.5% 3.8% 1.1% 5.7% K Modest Traditions 19.4% 15.3% 5.7% 13.8% 9.1% 5.8% L Transient Renters 20.0% 7.9% 5.0% 11.6% 5.7% 5.4% M Family Basics 15.8% 7.5% 10.8% 11.7% 6.1% 6.3% N Vintage Value 8.0% 8.1% 9.7% 8.6% 4.9% 5.8% O Municipal Challenge 8.0% 0.5% 4.7% 4.6% 1.6% 2.2% Source: Mosaic 2015, Experian

Group F, ‘Senior Security’ is the group with the highest numbers of people in Atherstone South & Mancetter ward. Dominant characteristics for this group include elderly singles and couples who are homeowners in comfortable housing on low incomes. ‘Suburban Stability’ also features heavily in Atherstone South & Mancetter ward (representing over 200 households); this group are more financially secure and are younger than Group F residents.

Figure 21 identifies the key Mosaic Groups in Atherstone and looks at their channel preference in terms of communication as well as how likely they may be to adopt technology. The mixed age profile of the Atherstone area has already been highlighted in the analysis above, so it is perhaps not unexpected that the communication channel preferences and attitudes to technology differ by group and this should be taken into account when considering any communication with residents in this area.

For example, residents who are in Mosaic Groups E and K prefer face-to-face communication and Group F residents prefer to communicate via letter. In the lifecycle of technology adoption, Group F residents are considered to be ‘laggards’ i.e. one of the last groups to adopt technology. It is worth noting that, of the top five Mosaic groups identified for Atherstone, none of them feature in the top three groups in terms of adopting technology (i.e. they are not considered to be ‘innovators’) or in the top four Mosaic Groups in terms of owning a smartphone or internet usage.

28 Figure 21: Channel preferences of the top Mosaic Groups in Atherstone Channel Preference Technology Mosaic Group (highest) Adoption

E Suburban Stability Early Majority

F Senior Security Laggards

K Modest Traditions Late Majority

L Transient Renters Early Adopters

M Family Basics Early Adopters

Source: Mosaic, 2016

HOUSEHOLDS

Projections show that there will be a 12% increase in number of households in North Warwickshire Borough by 2039 (based on 2014 ONS subnational population projections).

Atherstone Central has larger proportions of one person households, cohabiting couple households and lone parent households than other wards in Atherstone (Figure 22). In Atherstone Central ward, the highest proportion of residents living in one person households are those aged 50 or over. This proportion gradually increases as age increases.

Figure 22: Household composition by ward

Atherstone South and Mancetter

Atherstone North

Atherstone Central

0% 20% 40% 60% 80% 100% One person households Married or same-sex civil partnership couple Cohabiting couple Lone parent Other household types Source: 2011 Census

Home ownership is highest in Atherstone North ward where 72% of properties are owned. Atherstone Central ward has the most people who are renting properties; 27.8% of households rent through the social sector and 20.5% rent from a private landlord. Just over 7% of households in Atherstone Central ward have at least one bedroom less than required. At the time of the 2011 Census, 2.1% of households in Atherstone Central ward did not have central heating.

29 HEALTH

This section summarises the health of the population of Atherstone. Where data is not available for Atherstone, district or CCG level information is presented. Throughout data is benchmarked with England, where the data is RAG rated green signifies significantly better than England, amber similar and red worse.

SMOKING

Tobacco use remains the single greatest cause of death and illness in England. Smoking increases the risk of developing a wide range of health problems including cancers, circulatory problems and respiratory problems. Children and young people are particularly vulnerable to the effects of cigarette smoke whether exposed actively or passively. Smoking in pregnancy carries risks for both the mother and the foetus (Smoking: Harm Reduction, NICE guidance, 2013). Smoking increases health inequalities in that those who are more deprived are more likely to smoke and to suffer from adverse effects. Furthermore, those with existing mental health problems are more likely to smoke and less likely to have access to help to quit (Health matters: smoking and quitting in England, PHE guidance, 2015).

The estimated annual cost of smoking to the NHS in England is £2 billion and to social care is £1.1 billion (Tobacco economics, Action on Smoking & Health (ash), March 2017). However, the total cost to society (in England) is much greater at an estimated £12.9 billion per year including costs to the NHS, to employers, and environmental costs. Synthetic estimates at ward level give an average total cost to society of £1,852.67 per smoker per year across Atherstone Central, Atherstone North and Atherstone South & Mancetter wards. Tobacco costs the local economy 20.5 times more than the income generated from duty paid (Action on Smoking & Health ready reckoner - http://ash.org.uk/category/information-and-resources/local-resources/).

The prevalence of smoking is estimated from primary care Quality and Outcomes Framework (QOF) data and is available at surgery level. The prevalence of smokers at Station Street Surgery is significantly higher than both the Warwickshire North CCG and England rates (Figure 23). This may be due to the higher proportion of middle aged men registered at the practice. The prevalence at The Atherstone Surgery is not significantly different to the England figures. At both surgeries, the CCG and in England, the prevalence of smoking has been decreasing very slowly since 2013.

30 Figure 23: Smoking prevalence by GP surgery

Station Street The Atherstone Warwickshire North England Surgery Surgery CCG

2013/14 26.4% 19.9% 19.9% 19.1% 2014/15 25.9% 18.9% 19.0% 18.4% 2015/16 24.8% 18.6% 18.8% 18.1% Source: QOF, accessed through fingertips, Public Health England

Most smokers would like to quit. Using local support services results in a four-fold increase in successful smoking cessation compared to no help or over the counter nicotine replacement (Health matters: smoking and quitting in England, PHE guidance, 2015).

The proportion of smokers at Station Street Surgery being offered support and treatment to stop smoking within the preceding 24 months has increased gradually between 2012 and 2016 (Figure 24). At The Atherstone Surgery, after a dip in 2014/15, the rates are now comparable with Station Street Surgery. The proportion of smokers being offered smoking cessation treatment and support by both surgeries is significantly higher than the England rate. However, the GP patient survey data show that the proportion who identify as being ex-smokers at each of the practices is not significantly different to the England rates (PHE Fingertips).

Figure 24: Proportion of smokers offered treatment and support for smoking cessation Station Street The Atherstone Warwickshire England Surgery Surgery North CCG 2012/13 90.0% 88.9% 82.4% 82.2% 2013/14 92.2% 88.4% 87.2% 84.3% 2014/15 98.9% 83.6% 88.5% 85.8% 2015/16 99.6% 95.8% 92.2% 87.0% Source: QOF, accessed through Fingertips, Public Health England

31 Given the high prevalence of smoking, especially among the patients registered at Station Street Surgery, smoking cessation efforts in the area need to be supported and developed.

ALCOHOL MISUSE

Alcohol consumption patterns

Excess alcohol consumption is a recognised risk factor for a wide range of short and long term health problems. These can range from acute intoxication and related injuries to coronary heart disease and some types of cancer (Alcohol Guidelines Review, Department of Health, Jan 2016). The Local Alcohol Profiles for England (LAPE), using responses to the Health Survey for England, estimate the percentage of: adults who abstain from drinking alcohol, adults binge drinking on heaviest drinking day, and adults drinking over 14 units of alcohol a week, in Warwickshire. The data are based on self-reported drinking behaviour which may be prone to underreporting. Trend data is unavailable.

The LAPE estimates for 2011-2014 suggest the proportion of adults binge drinking on heaviest drinking day in Warwickshire, the West Midlands and England are all statistically similar (20.1%, 15.8% and 15.5%% respectively), but the proportion of adults drinking over 14 units of alcohol a week is significantly higher in Warwickshire than in the West Midlands and England (33.1%, 25.7% and 25.7% respectively. This information is not available for North Warwickshire or Atherstone.

Admission episodes for alcohol-related conditions

The directly age standardised rates (DSR) of admission episodes for alcohol-related conditions (narrow definition) in North Warwickshire Borough have been significantly lower than the England rates between 2010/11 and 2014/15 and have remained steady (Figure 25). The North Warwickshire Borough figures have also been consistently lower than Warwickshire figures, but only significantly lower in 2012/13 and 2013/14. Whilst this may reflect less pathology amongst the alcohol consuming population in the borough, there needs to be further work done to ensure that the lower admission rate is not a reflection of poor or restricted access to services.

32 Figure 25: Admissions for alcohol-related conditions

700

600

500

400

300 North Warwickshire Warwickshire England 200

100 Directly per Rate 100,000 Standardised Directly

0 2010/11 2011/12 2012/13 2013/14 2014/15

Source: Fingertips, Public Health England

Figure 26: Under 18 Hospital Admissions for Alcohol-Specific Conditions

70

60

50

40

30

Rate per 100,000 per Rate 20 North Warwickshire Warwickshire England 10

0 2008/09 - 10/11 2009/10 - 11/12 2010/11 - 12/13 2011/12 - 13/14 2012/13 - 14/15

Source: Fingertips, Public Health England

The rate of hospital admissions for alcohol-specific conditions amongst those aged under 18 in North Warwickshire Borough has more than halved between 2008/09-10/11 and 2012/13-14/15 (Figure 26). The rate in North Warwickshire Borough has been lower than England figures since the 2009/10-11/12 period, although the difference is not statistically significant. The rate in Warwickshire was only reported between the time periods 2010/11-12/13 and 2012/13-14/15, and has been higher than the North Warwickshire Borough figures throughout that period.

33 Admission episodes for alcohol attributable liver disease

The rate of admission episodes for alcohol attributable liver disease has been significantly lower in North Warwickshire Borough and Warwickshire than England rates between 2010/11 and 2014/15 despite some variation in the rates. North Warwickshire Borough experienced an increase between 2010/11 and 2013/14, before falling in 2014/15, whereas England rates have steadily increased during the five year period. Small numbers in the borough mean that the trend needs to be interpreted with care.

Alcohol-related Mortality

The rate of alcohol-related mortality in North Warwickshire Borough has been consistently lower than the England rates between 2010 and 2014, albeit not significantly lower (Figure 27). The Warwickshire figure has experienced a similar trend over the same period, apart from in 2014, where the difference between the Warwickshire and England rates was significantly different.

Figure 27: Alcohol related mortality, 2010-2014 50

40

30

20 North Warwickshire Warwickshire England DSR DSR per 100,000

10

0 2010 2011 2012 2013 2014

Source: Fingertips, Public Health England

DRUG & ALCOHOL TREATMENT SERVICES

In Warwickshire, there were 2,740 referrals to Addaction for specialist drug and alcohol treatment for the twelve month period 1st April 2016 to 31st March 2017. Of these, 2,454 relate to unique individual referrals. Any referrals where there is ‘No Fixed Abode’ or where the location was not known (these are usually the result of needle exchange referrals and referrals for clients who never engaged) have been removed to leave only unique individual referrals in the dataset which leaves 1,116 Warwickshire referrals in the time period. This data has been geocoded and mapped down to a local area level.

34 There were 88 unique individual referrals for specialist drug and alcohol treatment services in North Warwickshire Borough over the twelve month period. Almost one third (33%) of clients in North Warwickshire Borough resided in the combined Atherstone three wards (29 clients). Over half of the referrals (59%) were for clients residing in Atherstone Central ward (17 clients).

It is also possible to identify the substance group for the referred individual. The profile for the combined Atherstone area is different to the North Warwickshire Borough profile. In North Warwickshire Borough, 42% of clients were seeking treatment for alcohol issues, but by comparison in the combined Atherstone wards, 24% of clients were seeking treatment for alcohol issues. In the combined Atherstone wards, opiates were the main substance group that the client was seeking treatment for (28%) and clients more generally had issues with non-opiates (17%) and also non- opiates and alcohol (14%), when compared to the borough client profile (non opiates - 10% and non- opiates and alcohol - 7%).

OBESITY

Obesity is a term used to refer to excess body fat. There are several different ways to measure this in adults including waist circumference and body fat percentage. The most commonly used measure is body mass index (BMI). In England, obesity is defined as BMI of 30 kg/m2 or more.

Obesity in adults is associated with a wide range of adverse health outcomes. These range from musculoskeletal disorders to metabolic disturbances, such as diabetes, circulatory disorders, such as hypertension and cancers, such as breast cancer (National Obesity Observatory, 2017). In England, direct costs to the NHS for treating excess weight and associated illnesses have been estimated to range between £479.3 million in 1998 to £4.2 billion in 2007 (Economics of Obesity, PHE).

BMI is measured in primary care as part of the QOF. The prevalence of obesity in the adult (16+) population of Station Street Surgery has been significantly lower than the Warwickshire North CCG and England figures since 2010/11, falling from 9.6% to 7.1% in 2012/13 and remaining steady since (Figure 28). In contrast, the prevalence at The Atherstone Surgery was significantly higher than Warwickshire North CCG and national figures in 2013/14 having increased from 8.9% in 2010/11 to 11.6% in 2013/14. Prevalence has reduced in recent years but rates are still higher than the national prevalence.

Figure 28: Prevalence of obesity in the adult population (2010/11-2014/5 16+, 2015/16 18+)

14

12

10

8

6

4 Station Street Surgery The Atherstone Surgery Warwickshire North CCG England 2 Prevalence of obesity adultsin (%) 35 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Station Street The Atherstone Warwickshire England Surgery Surgery North CCG Prevalence Prevalence Prevalence Prevalence 2010/11 9.6% 8.9% 11.1% 10.5% 2011/12 8.4% 9.7% 12.4% 10.7% 2012/13 7.1% 11.1% 12.0% 10.7% 2013/14 7.2% 11.6% 10.4% 9.4% 2014/15 7.5% 10.3% 9.6% 9.0% 2015/16* 7.4% 10.7% 10.5% 9.5% Source: Fingertips, Public Health England *For 2015/16 the denominator used is the estimated number of patients aged 18 and over on the practice list, earlier data is 16 and over)

Some of the difference in levels of obesity between the patients registered at each surgery is likely to be due to the different age profiles. Since Station Street Surgery has more working age adults registered who are less likely to be attending the GP, there may be an under-representation of obese adults. Obesity increases with age and The Atherstone Surgery has an older population on average.

HYPERTENSION

Blood pressure is a measure of the force with which blood is pumped around the body. There is no strict threshold for the definition of hypertension (high blood pressure). Every 2 mmHg increase in systolic blood pressure is associated with a 7% increase in the risk of mortality from ischaemic heart disease and a 10% increase in the risk of mortality from stroke (NICE, 2011). In addition hypertension is associated with heart attacks, heart failure, cognitive decline and renal disease. Currently, hypertension is diagnosed where there is sustained elevated blood pressure over 140/90. Hypertension is an important, modifiable, risk factor for morbidity and mortality.

As well as increasing age, there are several modifiable risk factors for hypertension. These include a sedentary lifestyle, a diet high in salt or alcohol and a stressful lifestyle. The prevalence of hypertension based on disease registers is a reflection of both the underlying rates of hypertension and the systems in place to detect and record the diagnosis. The prevalence of hypertension at both surgeries in Atherstone and Warwickshire North CCG is significantly higher than the England figures (Figure 29). Whilst the trend in England has been relatively stable, the prevalence of hypertension in the CCG and The Atherstone Surgery has been increasing, whilst there has been a decrease in prevalence of hypertension at The Station Surgery. The most recent figures show similar levels of hypertension in the populations of both surgeries.

36 Figure 29: Prevalence of all patients with established hypertension 25

20

15 Percentage

10 Station Street Surgery The Atherstone Surgery Warwickshire North CCG England 5

0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Station Street The Atherstone Warwickshire England Surgery Surgery North CCG Prevalence Prevalence Prevalence Prevalence 2010/11 19.3% 15.0% 15.2% 13.5% 2011/12 19.2% 15.0% 15.5% 13.6% 2012/13 18.8% 15.2% 15.6% 13.7% 2013/14 18.5% 15.4% 15.7% 13.7% 2014/15 17.7% 15.7% 16.1% 13.8% 2015/16 16.9% 17.1% 16.1% 13.8% Source: Fingertips, Public Health England

Figure 30: Proportion of hypertensive patients with controlled hypertension (age <80), 2013/14

Source: Fingertips, Public Health England

37 Only one year of data (2013/14) is available to assess how well blood pressure is controlled (BP <=140/90 in people aged under 80 years). Both surgeries are well outside the 99.8% confidence interval around the England average, but for different reasons (Figure 30); Station Street surgery is significantly better than the England average whereas The Atherstone Surgery is significantly worse. There are more hypertensive patients registered at The Atherstone Surgery and their blood pressure control is more problematic. We have already noted that the registered population at The Atherstone Surgery is older and more obese than the population registered at Station Surgery. This may contribute to the differences seen in blood pressure control. However, it is suggested that there needs to be further exploration of other factors such as ease of access to services, patient factors around medication use and lifestyle or diet factors which may affect both the prevalence and control of hypertension.

FITTER FUTURES SERVICE

Fitter Futures Warwickshire services aim to support people across Warwickshire to improve their health through maintaining a healthy weight, become physically more active and having a healthier lifestyle. The Fitter Futures scheme in Warwickshire is coordinated by Nuneaton & Bedworth Leisure Trust and commissioned by Public Health, Warwickshire County Council. There are three main providers as part of this service. These are: Change Makers, Slimming World and Weight Busters. Brief summaries of the Fitter Futures Warwickshire services are included below:

• Family Weight Management Service (ChangeMakers) for families with overweight children

Change Makers is a family weight management service which provides a free of charge 9 week healthy eating, healthy lifestyles and physical activity programme for families who have at least one child aged 4-12 who is overweight. Families can self-refer to the programme or be referred by a professional.

From October 2015 (when Fitter Futures launched) to September 2017, the following intelligence was available for Atherstone Change Maker service users. It is worth noting that the courses are moved around within North Warwickshire to ensure all families have the opportunity to join a course.

There were 42 Atherstone service users of which there were: • 14 adults – all complete or currently attending a course • 28 children - 7 completers, 4 non completers, 9 currently on a course and 8 on hold

Their health improvement results are also shown in Figure 31 and show general improvement between week 1 and week 9.

38 Figure 31- Atherstone Change Maker Services Health Improvement Results Oct 2015-Sept 2017 Health Improvement results Week 1 Week 9 BMI 19.9 19.7 Fruit & Veg Intake (per day) 3 3.5 Physical Activity (Minutes per day) 52 63 Self Esteem 21 22 • Young People and Adult Weight Management on Referral

This service provides a free of charge 12 week programme of weight management support to young people aged 12-16 and adults aged 16+. There are two different organisations who provide this service. To be eligible for the programme people must have a body mass index (BMI) of 30 or more or a BMI of 28 if there are complex needs.

• Young People and Adult Physical Activity/Healthy Lifestyles on Referral (previously known as Exercise on Referral)

This service provides a 12 week programme of a physical activity/healthy lifestyle support to young people aged 12-16 and adults aged 16+. There are many organisations that provide this service. To be eligible for the scheme you must have a specific condition and be referred by a health/social care professional.

For Atherstone postcodes, we have intelligence on the number of referrals for all services and completers for the Physical Activity/Healthy Lifestyles referral service from when the Fitter Futures service commenced in October 2015. From October 2015, there were 417 referrals to for the Physical Activity/Healthy Lifestyles referral service in Atherstone:

• Three quarters (75%) of referrals were female • The top reason for referral was adult weight management, accounting for nearly half (45%) of referrals, followed by three in ten which were exercise referrals (Figure 32). • The majority of referrals to this service were from the GP Practice (59%) although 19% were self-referrals.

Figure 32 – Reasons for referral

Reason for referral Number % Adult Weight Management 189 45.3% Exercise Referral 123 29.5% Family Weight Management 80 19.2% Weight Management & Physical Activity 13 3.1% Cardiac 6 1.4% Maternal Pathway 5 1.2% Dementia 1 0.2% Total 417 100%

39 • Services to support Families who have children aged 0-5 and want to improve their health

There are services in Warwickshire that offer breastfeeding and weight management support.

• Slimming World

For Slimming World service users in the Atherstone area, there were 161 referrals and 82 completions from July 2015 to date. Two in five (40%) referrals to Slimming World were from the GP and 30% were from the Fitter Futures service. The majority of referrals and completions were women (89% and 88% respectively). The average weight loss percentage for those referred to Slimming World and those who completed was -4.6% and -6.8% respectively.

DIABETES

Diabetes is a group of common endocrine disorders which affect the way that glucose is processed in the body. The underlying mechanism can be one of insufficient insulin production (Type I diabetes) or inadequate response to the insulin produced (Type II diabetes), although there may be some overlap. Type I Diabetes tends to be diagnosed in childhood and Type II Diabetes in adulthood. However, with increasing obesity, these patterns are changing. Obesity, poor diet and sedentary lifestyle are the main modifiable risk factors for Type II Diabetes.

Although the risk factors vary, the health impacts of all types of diabetes are similar. Impacts include an increased risk of cardiovascular problems such as heart attacks and compromised blood supply to the limbs. There is also the potential for damage the kidneys, the eyes and the nerves.

Since 2010/11, the prevalence of diabetes in patients aged 17 and over has been higher in Station Street Surgery than in those registered to The Atherstone Surgery (Figure 33). However, the gap has decreased from 1.5% in 2011/12 to within 0.1% in 2015/16. The differences between the prevalence of diabetes at Station Street Surgery and Warwickshire North CCG are not statistically significant.

The prevalence of diabetes in The Atherstone Surgery has been significantly lower than the Warwickshire North CCG figures since at least 2012/13, despite a steady increase. The prevalence of diabetes in Warwickshire North CCG and England have steadily increased over the past six years, although the prevalence in Warwickshire North CCG have been significantly higher than the England figures.

40 Figure 33: Prevalence of diabetes in patients aged 17 and over, 2010/11 to 2015/16

Station Street Surgery The Atherstone Warwickshire North England Surgery CCG Prevalence Prevalence Prevalence Prevalence 2010/11 6.8% 5.6% 6.1% 5.5% 2011/12 7.3% 5.8% 6.4% 5.8% 2012/13 7.5% 6.1% 6.7% 6.0% 2013/14 7.4% 6.2% 7.0% 6.2% 2014/15 7.3% 6.4% 7.2% 6.4% 2015/16 6.8% 6.7% 7.3% 6.5% Source: Fingertips, Public Health England

As well as controlling blood sugar levels (HbA1c), the control of blood pressure and cholesterol are important. NICE recommends treatment targets for each of these: target Hba1c reduces the risk of all diabetic complications, target blood pressure reduces the risk of vascular complications and reduces the progression of eye disease and kidney failure and target cholesterol reduces the risk of vascular complications. Data is not available at surgery level regarding how well patients are meeting all three treatment targets, however, there is data on individual targets. In 2015/16, there was no significant difference between the proportion of patients with diabetes who achieved an HbA1c of less than or equal to 59mmol/mol (the target level) in England (60.1%), and The Atherstone Surgery (61.5%) or Station Street Surgery (55.9%). The proportion of patients with diabetes who achieved a blood pressure of 140/80 or less was significantly higher at Station Surgery (83.8%) than England (70.4%). The proportion at The Atherstone Surgery (68.3%) was not significantly different to the England rates. The proportions of patients with diabetes who achieved total cholesterol levels of 5mmol/l or less was similar in England (70%), The Atherstone Surgery (74.4%) and Station Street (68.7%) (data from QOF accessed via fingertips, PHE).

The management of diabetes is not significantly different in either of the Atherstone GP surgeries. The broad trends show increasing rates of diabetes, thus there is a continued need for preventative action. As suggested by the risk factors, prevention of diabetes requires a multi-pronged approach which enables healthier food choices and increases the amount of activity that an individual can undertake (National strategy & policy to prevent type 2 diabetes, NICE).

CORONARY HEART DISEASE

Coronary heart disease (CHD) refers to a group of problems which are caused by interruption to the blood supply of the heart. The blood flow is compromised by narrowing and stiffening of the arteries caused by the deposition of fatty plaques. This can lead to a range of symptoms, including angina, heart attacks and heart failure (NHS Conditions).

There are several well recognised risk factors for CHD. These include abnormal lipids levels (such as high cholesterol), high blood pressure, obesity, diabetes, smoking, lack of exercise and a diet low in

41 fruit and vegetables (Lancet 2004; 364: 937–52). The role of alcohol remains controversial but is likely to be dependent on the levels consumed.

The prevalence of CHD in the two GP practices in Atherstone, has been statistically similar to the prevalence in Warwickshire North CCG and the prevalence in the population of England since 2012. The prevalence in Station Street Surgery has been decreasing since 2009/10, from 3.8% of the practice population to 2.7% in 2015/16 (fingertips, PHE). Whereas, the prevalence in The Atherstone Surgery has seen very little variation during this time period ranging between 3.3% and 3.6%.

It is possible that the prevalence of CHD is not more distinct between the two surgeries despite their differing demographics, because some modifiable risk factors (obesity and hypertension) are higher in patients registered at The Atherstone Surgery whereas others (smoking) are higher in patients registered at Station Street Surgery.

STROKE

A stroke occurs when the blood supply to the brain is cut off, leading to rapid damage and swelling. There are two kinds of stroke, those caused by a blockage to the blood vessels supplying the brain (ischaemic stroke) and those caused by a blood vessel in the brain bursting (haemorrhagic stroke). The symptoms, disability and outcome of a stroke will depend on the part of the brain affected, the extent of the damage and the speed with which the blood supply is re-established (NHS Conditions).

Broadly speaking, the risk factors are similar to those listed above for CHD. There is a clearer increase in risk with excessive alcohol consumption. There is also an increased risk with pre-existing cardiac problems such as an irregular heart beat (Lancet 2010: 376; 112–23).

The proportion of The Atherstone Surgery’s patients that are on the stroke register has steadily increased over the last six years, from 1.6% in 2010/11 to 1.9% in 2015/16 (Figure 34). The increases were not statistically significant and the figures were not statistically different to the Warwickshire North CCG or England level figures at any point over the last four years. The proportion of patients at Station Street Surgery that were on the stroke register increased from 1.1% in 2010/11 to 1.8% in 2013/14, but saw a decrease in 2014/15, down to 1.2%. As with The Atherstone Surgery, the figures for Station Street Surgery were not significantly different to Warwickshire North CCG or England.

It is worth noting that the prevalence of an irregular heart beat and the proportion of those with an irregular heart beat who are receiving medication to prevent the formation of blood clots are similar across both surgeries, in the CCG and England (QOF via fingertips, PHE).

42 Figure 34: Prevalence of stroke over time 2

1.5

1

Station Street Surgery The Atherstone Surgery stroke regitster stroke Warwickshire North CCG England 0.5 Percentage of registered patients on the patients registered of Percentage

0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Source: Fingertips, Public Health England

Stroke is an important cause of disability. The Sentinel Stroke National Audit Programme (https://www.strokeaudit.org/) provides estimates for the incidence and outcomes following a stroke. These are not available at ward level. However, between April and July 2016, there were 279 new patients with a stroke admitted to the University Hospital Coventry and 81 cases admitted to George Elliot hospital. At six months after the event, approximately 36% of cases in our region have a disability which results in them requiring assistance to meet their basic needs (35% nationally). This may range from help with dressing or food preparation to needing assistance with all bodily functions (Stroke Audit, National Results). Therefore, with regard to addressing population needs, tackling the risk factors for stroke is important from both a health and a social care perspective.

NHS HEALTH CHECKS

The NHS Health Check is a free check-up of overall health for people aged 40-74 who haven't had a stroke, or don't already have heart disease, diabetes or kidney disease. The check indicates whether a person is at higher risk of these health problems, as well as providing advice on how to prevent them. Those over 65, will also be told the signs and symptoms of dementia to look out for. Figure 35 show the number of NHS Health Checks offered and completed for the three years 2014/15 – 2016/17 for the GP practices in Atherstone. Patients of The Atherstone Surgery are more likely to attend for a health check following an invite than patients of Station Street Surgery.

43 Figure 35– NHS Health Checks

2014/15 2015/16 2016/17 Offers Completed Offers Completed Offers Completed The Atherstone 1007 669 655 431 868 435 Surgery (66.4%) (65.8%) (50.1%) Station Street 103 17 199 81 86 29 Surgery (16.5%) (40.7%) (33.7%) Source: Local data (South Warwickshire Foundation NHS Trust)

CANCER

Cancer refers to a range of diseases caused by the uncontrolled growth of cells. The symptoms, outcome and risk factors depend on the cells affected. Although any part of the body has cancerous potential, more than half of new cases of cancer (53%) and nearly half of all cancer deaths (46%) in the UK are due to disease of the breast, prostate, lung or bowel (Cancer Research).

Cancer prevalence is lower in patients registered at the two GP practices in Atherstone than across Warwickshire North CCG and the general population of England (Figure 36). The prevalence of cancer in the population of Station Street Surgery’s patients has been significantly lower than the Warwickshire North CCG figures since 2012/13. The prevalence in the population of The Atherstone Surgery’s patients was significantly lower in 2012/13 and 2013/14.

The prevalence of cancer at Station Street Surgery had been almost constant between 2011/12 and 2014/15, ranging between 1.2% and 1.3%, until a large increase in 2015/16 to 2.2%. This pattern may be due to the fact that fewer older patients are registered at Station Street Surgery. The prevalence of cancer at The Atherstone Surgery increased in an almost linear fashion between 2011/12 and 2015/16, following the pattern seen regionally and nationally.

Figure 36: Prevalence of cancer 2011/12 – 2015/16

44 Station Street The Atherstone Warwickshire England Surgery Surgery North CCG Prevalence Prevalence Prevalence Prevalence 2011/12 1.2% 1.2% 1.7% 1.8% 2012/13 1.2% 1.5% 1.9% 1.9% 2013/14 1.3% 1.8% 2.0% 2.1% 2014/15 1.2% 2.0% 2.3% 2.3% 2015/16 2.2% 2.2% 2.4% 2.4% Source: Fingertips, Public Health England

Incidence rates of cancer in the Atherstone middle layer super output area (MSOA) are reported as standardised incidence ratios and cover the period 2010-2014. The incidence ratio of “All Cancer” in Atherstone MSOA was 6.4% lower than the England rate, a difference which was not statistically significant (Figure 37).

The incidence ratios of breast cancer, colorectal cancer and prostate cancer were also all lower in Atherstone MSOA compared to England level figures, 12%, 22% and 18% lower, respectively. However, due to the small numbers involved in Atherstone, these differences are not statistically significant. The incidence ratio of lung cancer was 3.5% higher in Atherstone MSOA, compared to England, although again, this difference was not statistically significant.

At a North Warwickshire Borough level, the incidence rates for “All Cancer”, colorectal cancer and prostate cancer were significantly lower than the England rate.

Figure 37: Standardised cancer incidence ratio, 2010-2014

45 Atherstone MSOA Warwickshire North CCG England All Cancer 93.6 96.7 100 Breast Cancer 88.0 101.3 100 Colorectal Cancer 77.9 86.0 100 Lung Cancer 103.5 100.3 100 Prostate Cancer 81.7 83.9 100 Source: Local Health, Public Health England

Given the deprivation in Atherstone in general and the higher rates of smoking at Station Street Surgery, cancer incidence would be expected to be higher than the England base rate. One way of assessing this is to review the number of referrals sent through the Two Week Wait (TWW) pathway where cancer is suspected. Data is presented as indirectly age-sex standardised ratios (Figure 38). This compares the rates of referrals observed to the rates expected if the English age-sex rates were applied to the local population. Some caution is needed with interpretation due to the relatively small numbers.

Figure 38: Trends in Two Week Wait referral rates, 2012/13-2015/16

Station Street Surgery The Atherstone Surgery England

2012/13 54 93 100 2013/14 81 92 100 2014/15 71 87 100 2015/16 69 94 100 Source: Fingertips, Public Health England

This data shows that there were significantly fewer than expected TWW (urgent) GP referrals from Station Street Surgery in 2012/13, 2014/15 and 2015/16. There were also significantly fewer than expected referrals from The Atherstone Surgery in 2014/15. There was no statistically significant difference in the proportion of TWW referrals resulting in diagnosis of cancer from either surgery compared to English data between 2009/10 and 2015/16.

46 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

COPD is a condition of the lungs which causes difficulty breathing and frequent chest infections. It is most often diagnosed in middle age. It is traditionally considered a disease which affects smokers.

The prevalence of patients with COPD in the population of both Station Street Surgery and The Atherstone Surgery is higher than the England rates (Figure 39). The prevalence in Warwickshire North CCG is significantly worse than the England rates. In Warwickshire North CCG and England, the prevalence of COPD has increased marginally since 2009/10. In the two surgeries, the rates have decreased slightly over the same time.

Figure 39: Trends in the prevalence of Chronic Obstructive Pulmonary Disease

Station Street The Atherstone Warwickshire North England Surgery Surgery CCG 2009/10 2.8% 2.8% 1.8% 1.6% 2010/11 3.0% 2.7% 1.8% 1.6% 2011/12 2.5% 2.6% 1.8% 1.7% 2012/13 2.5% 2.6% 1.8% 1.7% 2013/14 2.5% 2.5% 1.9% 1.8% 2014/15 2.5% 2.4% 1.9% 1.8% 2015/16 2.5% 2.3% 1.9% 1.9% Source: Fingertips, Public Health England

Smoking is the key risk factor for COPD and as noted above, significantly more of the patients registered at Station Street Surgery smoke than local and national figures.

Current smoking data will be reflected in future diagnoses of the condition, so the rates we are seeing now may reflect historical smoking patterns. However, exposure to occupational fumes and

47 vapours, outdoor air pollution and predisposing genetic factors may also be a risk factor. In terms of addressing these issues, changes in Health and Safety legislation should result in protection of people working in this country. Efforts are already underway to address air pollution nationally, but perhaps measurements of local air quality would shed light on the extent of the effect that this exposure is having locally.

DEMENTIA

Dementia is a broad term which refers to a range of different conditions. Symptoms belong to three different groups: cognitive impairment (such as problems with memory or language), psychiatric or behavioural disturbances (including depression and hallucinations) and difficulties with activities of daily living (such as driving or getting dressed). The prevalence of dementia increases with age. The most common types in the UK are Alzheimer's Disease and vascular dementia, which together account for 75% of cases of dementia (https://patient.info/doctor/dementia-pro).

In 2015, dementia and Alzheimer's Disease became the leading cause of death in England and Wales for the first time. This is, in part, a reflection of increased life expectancy and improved awareness of the condition, but may also be due to changes in the regulations around how cause of death is attributed (Registered deaths In England & Wales, Office for National Statistics).

The prevalence of diagnosed dementia in all ages across Warwickshire North CCG and England has doubled since 2010/11 (Figure 40). The prevalence in The Atherstone Surgery has increased from 0.3% in 2010/11 to 0.9% in 2015/16. The prevalence in Station Street Surgery however, has not increased at such a rate, only increasing from 0.3% in 2011/12 to 0.5% in 2013/14, then falling to and remaining at 0.4% for 2014/15 and 2015/16.

Figure 40: Trends in prevalence of dementia over time (all ages) 1 Station Street Surgery The Atherstone Surgery Warwickshire North CCG England 0.8

0.6

0.4 dementia

0.2

proportion of registered patients with with patients registered of proportion 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Source: Fingertips, Public Health England

48 At 31st March 2017 there were 1,323 people aged 65 and over diagnosed with dementia across Warwickshire North CCG (QOF-Estimated Dementia Diagnosis Rate in England, NHSE, April 2017). It is estimated that this figure should be 2,265 suggesting a dementia diagnosis rate in this age group of 58.4%; the national estimated dementia diagnosis rate is 67.6%. At 31st March 2017, 138 people aged 65 and over had a dementia diagnosis at The Atherstone Surgery (a prevalence of 4.1%) and 11 at the Station Street Surgery (a prevalence of 2.1%).

Some of the increases seen are a reflection of the ageing population, with age being a recognised non-modifiable risk factor for a range of different dementia types. However, there are modifiable risk factors for dementia which are similar to those for cardiovascular disease, namely diabetes, smoking, high blood pressure and sedentary lifestyle (Dementia UK Update, Alzheimer’s Society).

The annual cost of dementia to society (including estimates for unpaid carers) is £32,250 per person with dementia in the UK. Individual needs and costs are likely to vary and costs to healthcare (£5,272 per person) and the total spend on social care (£12,630) are only part of the picture (Dementia UK Update). The trends seen in the local area shows an increase in dementia prevalence.

The ‘bulge’ in the population pyramid (Figure 8) for the populations of both surgeries is in the age range 40 to 60 years. It is likely, therefore, that there will be acceleration in the increase of dementia as these individuals age. Furthermore, the narrowing of the population pyramid in the ages younger that this would suggest that there may be a shortage of informal carers available in the future. Dementia is therefore an important future cause for morbidity, mortality and health and social care need in the local population.

EMERGENCY HOSPITAL ADMISSIONS

Emergency admission data are presented using standardised admission ratios (SAR) combining data from 2010/11 to 2014/15 (Figure 41). These are derived by comparing the observed rate of admission to the expected rate of admission if the local area had the same admission experience as England as a whole. The benchmark, the ratio for England, is 100. All the SARs for the CCG are significantly lower than the England rate. At the MSOA level, only the SAR for all causes is significantly lower than the England rate. Although the SAR for COPD at the MSOA level is higher than England, this difference is not significant.

49 Figure 41: Standardised Admission Ratios for Emergency Admissions, 2010/11-2014/15

Source: Local Health, Public Health England

The SAR admission ratio does not differentiate between appropriate and inappropriate admissions. Although it is useful to see that the pattern of admission in Atherstone is not significantly different to England, it cannot be assumed from this that there are no areas requiring further improvement. In particular, the higher COPD admission ratio requires further investigation to see if more support is needed to implement primary care management of exacerbations.

MORTALITY

The most common causes of death in Atherstone MSOA between 2011 and 2015 were (in order of decreasing frequency):

• Acute myocardial infarction (44, 7.6%) • Lung cancer (30, 5.2%) • Chronic ischaemic heart disease (23, 4%) • Stroke (22, 3.8%) • Dementia (22, 3.8%). Source: HSCIC/ONS Primary Care Mortality Database

Trend data for Atherstone is not available due to small numbers. However, long term data in deaths registered in England and Wales show that between 2005 and 2015 there has been a reduction in deaths due to circulatory diseases in men and women (reduction of 36.9% and 37.9% respectively); cancer (10.7% and 8.3% respectively) and respiratory disease (15.8% and 13.4% respectively). (Registered deaths, ONS).

In Figure 42 we can see the standardised mortality ratio (SMR) based on combined data from 2010 to 2014 for selected causes of death at all ages compared to the benchmark (the ratio for England i.e. 100). In Atherstone MSOA, the SMR for Coronary Heart Disease (CHD) is significantly higher than

50 the benchmark. In the CCG as a whole, the SMRs for all causes and CHD are both significantly higher than the benchmark.

Figure 42: Standardised mortality ratios for selected causes of death, 2010-2014

Warwickshire North Atherstone MSOA England CCG All Causes 105.2 108.3 100 All Cancer 99.4 99.2 100 Coronary Heart Disease 125.9 111.1 100 Stroke 114.5 107.6 100 Respiratory Diseases 96.2 102.9 100

Source: Local Health, Public Health England

Figure 43 shows the SMRs for premature mortality for selected causes. The ratios were generated using mortality data from 2010 to 2014.

51 Figure 43: Standardised mortality ratios for selected causes of premature death, 2010-2014

Warwickshire Atherstone MSOA England North CCG All Causes, <65 Years 130.6 100.9 100 All Causes, <75 Years 122.8 104 100 All Cancer, <75 Years 102 97.3 100 Coronary Heart Disease, <75 Years 167.3 110.2 100 Source: Local Health, Public Health England

In Atherstone MSOA, the SMR for death by all causes under the age of 65 years, or 75 years is significantly higher than the benchmark. The SMR for CHD is markedly higher than the England ratio.

At a national level, there have been significant improvements in mortality secondary to all three major groups of causes. Both locally and nationally, CHD is a significant problem in terms of both morbidity and mortality. There are several modifiable risk factors for CHD including smoking, diabetes, hypertension, obesity and a sedentary lifestyle. The information available about these risk factors is presented above. The mortality data add further weight to the importance of addressing these risk factors locally. The ranking by cause of death includes lung cancer and thus helps identify smoking cessation as a key intervention in Atherstone.

52 MATERNAL AND CHILD HEALTH

Infant Mortality

Infant mortality is defined as the number of children who die under the age of one year out of all live births in the same time period. Infant mortality reflects maternal and child health and is an important indicator of the health of society. It also gives an indication of health inequalities and deprivation. Smoking in pregnancy and maternal obesity are recognised risk factors for infant mortality. Breastfeeding exerts a recognised protective effect (Healthy Lives, Healthy People, HM Government, 2010).

Despite the rates of infant mortality being higher in North Warwickshire Borough compared to Warwickshire and England, these differences are not statistically significant (Figure 44). Rates of infant mortality have decreased steadily between 2009-11 and 2012-14, in all three geographic areas. However, figures in 2013-15 spiked slightly in North Warwickshire Borough and Warwickshire, although the difference was not statistically significant. The small numbers make seeking statistical significance difficult. A difference of nearly 2 per 1,000 live births between Warwickshire and North Warwickshire Borough requires further investigation.

Figure 44: Infant mortality rates over time

10 North Warwickshire Warwickshire England 8

6

4

1,000 per Rate, Crude 2

0 2009-11 2010-12 2011-13 2012-14 2013-15

Source: Fingertips, PHE

Low Birth Weight of Term Babies

Low birth weight (LBW) of term babies is defined as live births with a recorded birth weight under 2500g and a gestational age of at least 37 complete weeks. A healthy birth weight is an indicator of good maternal health and wellbeing during pregnancy. LBW is associated with complications both during the neonatal period and in adult life. Being a lone mother, a teenage mother or having multiparous pregnancy increases the risk of LBW. Other risk factors include consuming alcohol in pregnancy and smoking in pregnancy (PHE guidance, Health matters: giving every child the best start in life, 2016).

53 In 2015, the proportion of all live births at term with LBW was 2.8% in North Warwickshire Borough. Since 2011, this proportion has been between 2.1 and 2.8% and statistically similar to the proportion in England. Although, there are only a small proportion of LBW babies, it is important to assess if all risk factors are being addressed.

SMOKING IN PREGNANCY

Smoking in pregnancy poses a significant risk to mothers and babies including complications in labour as well as sudden infant death, LBW and increased neonatal mortality. There is increasing evidence of the long term harm caused by smoking in pregnancy. These include an increased risk of asthma, ear, nose and throat infections, psychological problems in childhood and poor school performance (NICE guidance, 2010).

Treating these and related problems puts considerable pressure on the NHS. The total annual cost is estimated to range between £8.1 and £64 million for treating the resulting problems for mothers and between £12 million and £23.5 million for treating infants (aged 0–12 months) (NICE guidance, 2010).

Figure 45: Proportion of births to mothers who smoke, by CCG

Source: Public Health England

In Warwickshire North CCG, there have been dramatic year on year decreases in the proportion of mothers who smoke from around 18% in 2013/14 to round 12% in 2015/16 (Figure 45). However, rates are still higher than those in South Warwickshire and England as a whole. This would suggest that previous measures have had some success, but that ongoing efforts are needed.

54 NATIONAL CHILD MEASUREMENT PROGRAMME (NCMP)

The NCMP was set up in line with the Government's obesity strategy and aims to weigh and measure children in order to map trends and inform planning of local services. Children are becoming obese at a younger age and staying obese for longer. Those who are obese in childhood are more likely to be obese in adulthood; the health consequences of this have been discussed above. Childhood obesity disproportionately affects children from more deprived backgrounds further exacerbating health inequalities (Child Obesity National Guidance, 2017).

Proportionately more children in Atherstone, in both reception (aged 4-5) and year 6 (aged 10-11), have ‘excess weight’ (includes children who are overweight or obese) when compared with levels for North Warwickshire Borough and Warwickshire as a whole (Figure 46). Children in both reception and year 6 are more likely to be obese in Atherstone compared to children in North Warwickshire Borough and county wide (Figure 47).

Figure 46: Proportion of reception and year 6 children who have excess weight, 2015/16

North Atherstone Warwickshire Warwickshire England Borough Reception 30.5% 23.2% 20.6% 22.2% Year 6 38.3% 34.7% 30.8% 33.4% Source: NCMP

Figure 47: Proportion of reception and year 6 children who are obese, 2015/16

Atherstone North Warwickshire England Warwickshire Borough Reception 15.3% 9.9% 8.3% 9.3% Year 6 21.5% 19.3% 16.3% 19.0% Source: NCMP

The proportion of reception age children in Atherstone who have excess weight is almost 10 per cent higher than the county average. In Year 6 children the proportion is 7.5 per cent higher. Half of children of reception age in Atherstone who have excess weight are obese, compared with around 40% countywide.

In general, there is an upward trend in the proportion of both reception and year 6 children in Atherstone who are overweight and obese (Figure 48). Year 6 children in Atherstone show the largest increase in the proportion of those who have excess weight between 2010/11 and 2012/13 to 2012/13 and 2013/14 when compared to North Warwickshire Borough, Warwickshire and the national picture. Rates of obesity for year 6 children in Atherstone have remained fairly static during the five year monitoring period in line with county and national trends.

55 The three year average level of excess weight in reception age children in Atherstone has risen by around 2 percentage points between 2010/11 and 2014/15. During the same period rates of excess weight have risen by 0.5 percentage points in Warwickshire.

Figure 48: Proportion of reception age children who have excess weight over time 35%

30%

25%

20%

15% Atherstone North Warwickshire Warwickshire England 10%

5%

0% 2010/11 to 2012/13 2011/12 to 2013/14 2012/13 to 2014/15

Source: NCMP

Figure 49: Proportion of reception age children who are obese over time

20%

15%

10%

5% Atherstone North Warwickshire Warwickshire England

0% 2008/09 to 2010/11 2009/10 to 2011/12 2010/11 to 2012/13 2011/12 to 2013/14 2012/13 to 2014/15

Source: NCMP

56 Figure 49 indicates that obesity levels in reception age children have risen more markedly in Atherstone when compared to elsewhere. Obesity rates are 3.6 percentage points higher in Atherstone in 2013/13 to 2014/15 than they were in 2008/9 to 2010/11. During the same period rates in Warwickshire rose by 0.6 percentage points.

The rate of increase in obesity in reception age children is concerning. To some extent, this may be due to deprivation in the area. However, an assessment of the ability to access healthier food choices and safe exercise spaces may help to determine the focus of ongoing efforts to address this issue.

TEENAGE PREGNANCY

England still has higher teenage (under 18) conceptions than many of our western European counterparts. Although, teenage pregnancy can be a positive experience for mothers and children it is an important public health issue for several reasons. In terms of child outcomes there are higher rates of neonatal mortality and stillbirth, LBW and infant mortality. In terms of maternal outcomes, there are increased rates of poverty and poor mental health in those who have children under the age of 20 (Local Government Association, 2016). In addition, providing termination services and additional support to young parents can be resource intensive. As a result continuing to decrease the rate of conceptions in women under the age of 18 years remains a key objective for the Department of Health.

The risk factors for teenage pregnancy are complex. All measures of deprivation are associated with increasing teenage pregnancy (Community Health 2015; 69:49–54). Early onset of sexual activity may be associated with riskier sexual behaviour around contraceptive use. Furthermore, low educational attainment, disengagement from school and being a looked after child also increase the risk of teenage conceptions (National Child & Maternal Health Intelligence Network).

There has been significant progress in decreasing teenage pregnancies across England. The rate of teenage conceptions has nearly halved in North Warwickshire Borough, Warwickshire and England since 1998 (Figure 50). The fluctuations seen in the trend in North Warwickshire Borough are likely to be a result of small numbers. Over the same time period the proportion of conceptions in those aged under 18 in North Warwickshire Borough ending in terminations has varied between 40.5% and 62.5%. There have been significant fluctuations and therefore it is difficult to be sure of trends. However, these figures do raise the issue that many of these pregnancies are unwanted and unplanned.

57 Figure 50: Trends in the under 18 conception rate

Source: ONS, accessed via fingertips, PHE

At ward level, the rates of teenage pregnancy between 2012 and 2014 in Atherstone Central are significantly higher than the Warwickshire and England rates (Figure 51). However, the rates in Atherstone North ward are not significantly different and those in Atherstone South & Mancetter ward are suppressed due to small numbers. Atherstone Central is the most deprived of the three wards and this may explain some of the excess in rates of teenage pregnancies in the area.

The two factors for which there is the strongest evidence in reducing teenage pregnancies are comprehensive education and support combined with young-person friendly reproductive health services (Teenage Pregnancy Strategy, DH & DCSF, 2010). At present, there is a multi-agency working group looking to develop a strategy to address these issues in the north of the county.

58 Figure 51: Teenage pregnancy rates, ward level, 2012-2014

Source:http://atlas.chimat.org.uk/IAS/dataviews/report/fullpage?viewId=498&reportId=511&geoId=100&geo ReportId=4644

BREASTFEEDING

Current policy in the UK is to promote exclusive breastfeeding for the first six months of life. Breastfeeding is associated with fewer gastrointestinal and respiratory infections in childhood and lower rates of obesity in later childhood (NICE guidance, 2014).

Data is available on the rates of breastfeeding either totally or partially at 6-8 weeks after birth. In 2014/15 North Warwickshire Borough has significantly fewer breastfeeding mothers compared to England (34.1% compared to 43.8%). The Warwickshire trend is similar to the trend in England. In 2014/15, Warwickshire had significantly better rates of breastfeeding (46.9%) than England.

The picture at six months after birth is likely to show even lower rates of breastfeeding as national surveys show that a further 25% of mothers stop breastfeeding between 6-8 weeks and six months. In comparison, data from Norway shows breastfeeding rates of 80% at six months. Three quarters of

59 mothers who have stopped breastfeeding said that would have liked to continue (NICE guidance, 2014). Whilst some measures to encourage breastfeeding remain in the realm of national policy, it would be useful to understand attitudes and barriers locally in order to establish appropriate support strategies.

SEXUAL HEALTH

Sexual health is a broad term covering contraception, sexually transmitted diseases and personal relationships. As such, good sexual health is important for both individuals and communities. Data about teenage conceptions reflect some aspects of sexual health service provision and these have been discussed above. Sexual Health indicators are not reported below District/Borough level, therefore have been presented at North Warwickshire Borough level.

All New Sexually Transmitted Infection (STI) Diagnosis Rates

The rates of All New STI Diagnosis rates (excluding chlamydia) in those aged under 25 have been significantly lower in North Warwickshire Borough and Warwickshire than the England figures, over the past four years (Figure 52). The rates in both geographies reached their peak in 2013, at 641 per 100,000 population in North Warwickshire Borough and 732 per 100,000 in Warwickshire.

Figure 52: New Sexually Transmitted Infection (STI) Diagnosis Rates 1000 North Warwickshire Warwickshire England

800

600

400 Per 100,000

200

0 2012 2013 2014 2015

Source: Fingertips, Public Health England

This may represent a genuinely lower rate of STIs in North Warwickshire Borough. However, it may also be that individuals are either not being tested or are being tested elsewhere, outside the borough.

Chlamydia Detection Rate

Chlamydia is the most common bacterial STI in England and young adults are disproportionately affected. The National Chlamydia Screening Programme recommends that all sexually active individuals under the age of 25 are tested annually or on partner change. In 2016, the proportion of

60 15-24 year olds screened in North Warwickshire Borough (15.5%) and Warwickshire (13.6%) as a whole remains significantly lower than the proportion screened in England (20.7%) or the West Midlands (16.4%). In all areas, there is a gradual downward trend in the proportion screened. Some caution is needed with interpreting the results as they refer to the number of tests done rather than the number of individuals tested.

Figure 53: Chlamydia Detection Rate per 100,000, 2012-2015 (benchmarked against the target rate of 2,300 where red <1,900 and amber is 1,900-2,300)

North Warwickshire Warwickshire England Borough 2012 1,444 1,508 2,095 2013 1,391 1,543 2,088 2014 1,223 1,569 2,035 2015 1,990 1,438 1,914 2016 1,739 1,361 1,882 Source: Fingertips, PHE

The chlamydia detection rates per 100,000 in residents aged 15-24 in North Warwickshire Borough were significantly lower than the target rates between 2012 and 2014, and again in 2016 (Figure 53). In 2015, despite decreasing proportions being screened, the rate in North Warwickshire Borough increased to 1,990 per 100,000. The target rate for chlamydia detection is 2,300 which was not achieved in the four year period in any of the three geographies.

Encouraging young people to engage with screening appears to be a challenge in the country as a whole and this is also seen in Warwickshire. Since the data is not available for the smaller geographical areas, it is difficult to be sure what the situation is in Atherstone. It seems reasonable to assume, given the higher rates of teenage pregnancies in Atherstone Central, that we may also see higher rates of STIs in this ward. As with teenage pregnancies, system-wide, life course approaches are needed to result in meaningful and sustained reductions in STIs in Atherstone.

Use of Long Acting Reversible Contraceptives (LARC)

LARC are reliable methods of contraception which, once fitted, do not require any further action from the user. They include intra-uterine devices, intra-uterine systems and implants. Measuring provision of LARC is seen as a proxy measure for access to the full range of contraceptive options. There are no targets in place as the aim is to provide choice rather than to impose the use of these methods. LARC do not protect against STIs. In North Warwickshire Borough and Warwickshire the rate of LARC use is significantly higher than the rate in England or West Midlands. This would suggest that there is good access to reproductive health choices in the area.

61 SCREENING

Screening is the process of identifying otherwise healthy people who may be at risk of a disease or condition. The rationale with regards to cancer screening is that detecting cancer early can result in preventative action being taken at stage when tumours are small. This can result in more effective and lower risk treatment being offered. One of the challenges of an effective screening programme is that no test will completely accurately detect or rule out the disease of interest. As a result there may be false positives (causing unnecessary anxiety) or false negatives (offering false reassurance).

Rates for breast, bowel and cervical screening coverage in North Warwickshire Borough are significantly better than England and similar to Warwickshire.

MENTAL HEALTH

One in four adults in the West Midlands Combined Authority area will be diagnosed with a mental health problem in any given year (Mental Health in WMCA). Mental ill health includes a range of different diagnoses with different symptoms and causes. These problems may be less visible than physical ailments, but they place a significant burden on individuals and services. Mental ill health costs the NHS approximately £2 billion a year in the West Midlands Combined Authority area and accounts for approximately a third of all the costs to the local economy. It is the single largest cause of disability in the UK. The human cost is more difficult to measure but is likely to be significant.

Mental health problems are not equally distributed across the country. There are associations with social deprivation, local environment and local economy. Furthermore, there are groups who are at increased risk such as children in care, homeless groups, the unemployed and black and ethnic minority populations (Mental Health in WMCA). Half of all mental health problems are established by the age of 14 and many can be viewed as chronic relapsing and remitting disorders. In the absence of adequate interventions, this can set off a downward spiral for affected children and their families (The Five Year Forward View for Mental Health).

The CCG estimates that 11.4% of the population in Warwickshire North CCG has one of the common mental health problems. The prevalence of depression in adults (18+) in the Station Street Surgery patients has remained consistently below the England rate and has been below the CCG rates since 2014/15. At The Atherstone surgery, rates have been significantly lower than the England and CCG rates since 2012/13. After a sharp dip in 2012/13, the prevalence of depression is once again increasing (Figure 54). Similarly, the number of new cases of depression in England, West Midlands and the CCG has been increasing since 2012/13. The incidence in Warwickshire North CCG remains significantly lower than the England figure throughout the time period.

62 Figure 54: Depression prevalence (aged 18+), 2009/10-2015/16

Station Street The Atherstone Warwickshire North England Surgery Surgery CCG

2009/10 8 12.1 6.9 10.9 2010/11 7.8 12.1 7.1 11.2 2011/12 7.3 12 7.8 11.7 2012/13 4.5 3.8 4.4 5.8 2013/14 4.2 4 5 6.5 2014/15 4.6 4.2 5.8 7.3 2015/16 6 4.3 7.1 8.3 Source: Quality Outcomes Framework – accessed via Fingertips

Data around the burden of illness in children is less robust. However, there are estimates which suggest that the prevalence of mental health problems in children in North Warwickshire Borough is 9.4% and this is similar to the England and West Midlands rates (statistical tests not carried out).

Self-harm and suicides are two of the more visible manifestations of mental illness. The directly age- standardised three year average suicide rates in adults are presented in Figure 55. Between 2013- 2015, the suicide rate in Warwickshire was significantly higher than the rate in England, but not significantly different to rate in the West Midlands.

63 Figure 55: Age standardised suicide rate

Source: Fingertips

Locally collected data for hospital admissions related to self-harm are available at ward level (Figure 56). The rate in Atherstone Central ward is almost double that of Atherstone South & Mancetter ward. Trend data is not available. The diagnostic codes reported are specifically those related to intentional self-harm by poisoning and other means. Data for 49 hospital admissions for self-harm for the period 1st April 2015 to 31st March 2017 for the three wards in Atherstone revealed that the highest proportion of admissions was in the 10-19 age group (35%) with 18% being 20-29 year olds, 12% 30-39 year olds, 14% 40-49 year olds and 20% aged 50 or over.

Figure 56: Rate of hospital admissions related to self-harm April 2013 – December 2016

Ward Rate per 1000 person Atherstone Central 13.6 Atherstone North 11.1 Atherstone South & Mancetter 7.3 Source: Locally collected data from WNCCG

The standardised admission ratio of hospital stays for self-harm is significantly higher in the Atherstone MSOA than in England, around 52% higher; the rate for Warwickshire North CCG is around 28% higher than England.

Suicide and self-harm data needs to be interpreted with caution due to the small numbers involved. Furthermore, the numbers alone do not give an indication of the lived experience of those being counted. For example, we cannot comment on the number of cases of attempted suicide compared to suicide. It is also difficult to extract data about death due to suicide at ward level. That the suicide levels are so much higher than the England rates despite lower rates of depression may be due to the presence of other mental health problems, more severe mental health problems or difficulty with access to services. A Warwickshire Suicide Prevention Strategy has been launched with a zero

64 suicide commitment; it will be interesting to see if and how this translates to changes in these figures.

CARERS

The Carers Trust describes the role of a carer as ‘anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support’(Carers Trust).

Carers UK research suggests that demographic change, coupled with the direction of community care policy mean that the number of carers could increase by 40% by 2037 (Carers UK 2012: Facts about Carers). The latest projections show that over the next 20 years the number of people aged over 85 is expected to double. There is also a continuing shift away from institutional care to care provided at home and in the community. It is important to recognise this pressure on families to care in their own homes, particularly for spouses and partners, is growing significantly and is predicted to double over the next 30 years (Personal Social Services Research Unit, ‘Informal Care for Older People provided by their adult children). Families provide the majority of care in the UK and it is clear this trend is likely to continue. This contribution is worth an estimated £119 billion a year to the UK economy – more than the total cost of the NHS (Valuing carers – Calculating the value of unpaid care, 2007).

The 2011 Census provides a valuable update on the picture of unpaid care provision in North Warwickshire Borough. The Census indicates that North Warwickshire Borough has 7,519 people or 12% of the population providing some form of unpaid care each week in 2011. The borough has the highest rate of unpaid carers in Warwickshire when compared with the other Districts/Boroughs. This has increased by nearly 450 people from the 2001 Census, an increase of 6.4% in those residents providing some form of unpaid care in North Warwickshire Borough.

Another source of information on carers is GP Patient registers. An estimated 21.4% of patients registered with a GP in Warwickshire North CCG had some form of caring responsibility in 2014/15, which is higher than the national average (18.2%). This represents a significant difference when compared with the 2011 Census (11.7%), with GP practices effectively identifying nearly twice as many carers in the 2011 Census. However, this varies considerably for the two GP surgeries in Atherstone. Atherstone Surgery has 21.9% of patients registered as having a caring responsibility, compared to 14.7% in Station Street Surgery. This difference is demonstrated in Figure 57 and is helpful in informing targeted activity related to carers in Atherstone.

At ward level, the 2011 Census identifies over 1,300 carers in the three Atherstone wards (Figure 58). Atherstone North and Atherstone South & Mancetter wards have the highest proportion of unpaid carers (12.5% and 12.4% respectively), slightly above the borough average. This increases with the number of hours of care provided, with 3.4% of residents providing 50 or more hours of unpaid care in these two wards compared to a borough average of 2.9% and a county average of 2.3%.

65 Figure 57: Proportion of patients with a caring responsibility, GP surgeries in Warwickshire North CCG, 2014/15

Source: Fingertips, Public Health England

Figure 58: Number of hours of care provided, 2011 Census

Total number of Provides 1-19 hours Provides 20-49 hours Provides 50+ hours unpaid carers of unpaid care of unpaid care of unpaid care Number % Number % Number % Number % England 5,430,016 10.2 3,452,636 6.5 721,143 1.4 1,256,237 2.4 Warwickshire 59,240 10.9 39,871 7.3 6,917 1.3 12,452 2.3 Warwickshire North 21,748 11.7 13,354 7.1 2,919 1.6 5,478 2.9 CCG North Warwickshire 7,519 12.1 4,797 7.7 924 1.5 1,798 2.9 Borough Atherstone Central 444 11.3 261 6.6 61 1.5 122 3.1 Atherstone North 425 12.5 257 7.5 53 1.6 115 3.4 Atherstone South & 454 12.4 279 7.3 52 1.4 123 3.4 Mancetter Source: 2011 Census

The 2011 Census figures show a general increase in the number of carers from the previous 2001 Census (Figure 59). The most pronounced increase has been in Atherstone Central ward which has seen a 30% rise in the number of unpaid carers between 2001 and 2011. This compares to an increase in North Warwickshire Borough of 6.4%. In fact, the rise in Atherstone Central ward alone

66 accounts for nearly a quarter (23%) of North Warwickshire Borough’s total increase over the ten year period.

Figure 59: Change over time in care provided, 2001-2011

Source: Office for National Statistics

Women are much more likely than men to provide unpaid care (56% and 44% respectively in Atherstone). This gender difference remains broadly similar irrespective of the number of hours of care undertaken each week. Unsurprisingly, rates of unpaid care provision increase with age among both men and women, up to the age of 65. The data indicates that the share of unpaid care provision is highest for women aged 50-64 years.

There is a uniform pattern of deteriorating general health with rising levels of unpaid care provision. There is a clear relationship between poor health and caring that increases with the duration and intensity of the caring role. Those caring for 50 hours or more per week are at far greater risk of poor health than those caring for fewer hours. Just over 12% of carers in Warwickshire who provide 50 or more hours of care a week state that their health is either ‘bad or very bad’ compared to 4.6% among those who provide no care and 4.0% of other carers.

Over 16% of carers in Atherstone Central ward who provide 50 or more hours of care a week state that their health is either ‘bad or very bad’ compared to 7.3% who provide no care and 6.8% of other carers. The equivalent proportions of carers in Atherstone North ward and Atherstone South & Mancetter ward who provide 50 or more hours of care a week, state that their health is either ‘bad or very bad’ is 13% and 11.4% respectively.

This additional health risk attached to those who provide 50 hours or more care when compared with both non-carers and those who care for less than 50 hours is evident among all age groups in

67 both Warwickshire and England. There is national evidence to suggest that a significant number of hospital admissions are due to problems associated with the carer rather than the person admitted. One study found that problems associated with the carer contributed to readmission in 62% of cases (Williams, E, Fitton, F (1991), ‘Survey of carers of elderly patients discharged from hospital’. British Journal of General Practice, 41, 105-108). A national study tracking a sample of people over 75 years old who had entered the health and social care system, found that 20% of those needing care were admitted to hospital because of the breakdown of a single carer on whom the person was mainly dependent.

The difference between the health status of those providing unpaid care, and those who do not, is most pronounced among those aged 0-24 years. Nationally, young carers are twice as likely to report that their health is ‘not good’ compared with their peers who provide no care. This difference increases with young carers who care for 50 hours or more per week; they are five times more likely to report their health as ‘not good’ compared to those of the same age providing no care. This implies that high levels of unpaid care have a greater adverse effect on the health of young people.

North Warwickshire Borough, despite having the fewest young carers in the county, has the highest proportion of young carers providing 50 or more hours of unpaid care per week (Figure 60) and therefore unpaid care provision is an important consideration in the borough and in Atherstone.

68 Figure 60: Proportion of carers in Warwickshire providing 50 or more hours of care per week, 2011

69 SOCIAL CARE

This chapter will include information on both adult and children’s social care and provide an overview of the Atherstone families attached to the Priority Families programme. The data for these areas is held by Warwickshire County Council.

PRIORITY FAMILIES PROGRAMME

The Priority Families programme commenced in Warwickshire on 1st April 2012 and is now in Phase Two. The programme is a local programme supporting the national Troubled Families programme, and focuses on the earliest possible intervention, working with vulnerable families which have multiple problems that can be expensive to address. In Phase Two the headline criteria for identification for families is much broader and more flexible and covers crime, anti-social behaviour, education, children who need help, worklessness, domestic abuse and health issues.

At the end of Year 2 of Phase 2 of the programme (March 31st 2017) the target number of families to attach to the programme (1,467 families) was achieved. In order for a family to be attached to the programme, a family has to meet at least two of the six headline criteria and a number of key principles need to be satisfied:

• There will have been an assessment that takes into account the needs of the whole family. • There is an action plan that takes account of all (relevant) family members • There is a lead worker for the family that is recognised by the family and other professionals involved with the family • The objectives in the family action plan are aligned to those in the Priority Families Outcomes Plan.

At the end of year 2 in phase 2, a total of 563 families have been evidenced as achieving significant and sustained progress against their problems (95% for progress against headline criteria, and 5% for a family member on out of work benefits entering and sustaining employment). Focusing on the three Atherstone wards of Atherstone Central, Atherstone North and Atherstone South & Mancetter, the Priority Families data team have confirmed that in February 2017 there were 35 families attached to the programme living in these areas (with 80 children between them). The highest number of children in these families live in the Atherstone Central ward (41) followed by the Atherstone South & Mancetter ward (28) and then Atherstone North ward (11).

Of the 35 families, all of the families meet the headline criteria ‘Children Needing Help’ (100%) where one or more children in the family meet the threshold criteria in the Warwickshire ‘Thresholds for Services’ document for Tier 2, 3 or 4. It may also be that a child within the family is not school ready.

Figure 61 shows that families living in Atherstone North ward have a high proportion which meet other criteria and have issues such as domestic violence and abuse (91%), crime and anti-social

70 behaviour (82%), financial exclusion (82%) and health issues (82%). These issues will be tackled by the key worker with the families once they are attached to the programme. Only in making significant progress in these areas can a family be considered to have made ‘significant and sustained progress,’ for example where education is an issue the child attends school for more than 90% for three consecutive terms.

Figure 61: Proportion of Families which meet the six headline criteria - Atherstone Wards

1. Crime 2. 3. 4. 5. 6. Health / ASB Education Children Financial Domestic Needing Exclusion/ Abuse/ Help NEET Violence Atherstone Central 41% 59% 100% 66% 37% 66% Atherstone North 82% 64% 100% 82% 91% 82% Atherstone South & Mancetter 25% 68% 100% 50% 25% 54% Combined Wards Total 41% 62% 100% 62% 40% 64% Source: Warwickshire Priority Families Programme

When compared to Priority Families programme data for Warwickshire families, the data reveals that Atherstone families are more likely to have issues with crime and/or anti-social behaviour and be experiencing, or have experienced, issues with domestic abuse.

In Warwickshire, almost one third of families attached to the programme (32%) were eligible due to issues with crime and/or anti-social behaviour, this can be compared to Atherstone families where 41% of families have issues of this type. Focusing on domestic abuse, 40% of families in Atherstone were eligible for the programme due to them experiencing, or having experienced domestic abuse in the past, which is higher than the Warwickshire figure of 35%. Both areas need further investigation as to the reasons why Atherstone families may be presenting with issues of these types and preventative work around crime and anti-social behaviour, and also early signposting for domestic abuse for families, could be considered.

It is recommended that the Priority Families data team use the Mosaic dataset (customer segmentation tool) to profile Atherstone families attached to the programme and reveal which Mosaic groups and types that the families fall into. This will help identify the preferred communication channels that families will be most receptive to and this could help with targeting preventative and signposting advice related to domestic abuse, criminal and anti-social behaviour in the future. Identifying the Mosaic groups and types for these families means that it will be possible to see where these families more generally are located across the three Atherstone wards and preventative work and advice could be targeted at these groups.

Almost half of the children (49%) living in Atherstone Priority Families have a Common Assessment Framework (CAF) plan open and over one third (34%) of the children are in contact with social care and have an open plan in place (Figure 62). All of the families have a key worker (or lead professional) assigned to them and are receiving direct support.

71 Figure 62: Proportion of Families and their attached (primary) plan - Atherstone Wards

CAF Priority CAF Family Social Targeted Youth Plan Families Family Group Care Youth Justice Family Support Conference Plan Support Plan Support Worker Plan Plan Worker Plan Plan Atherstone Central 44% 5% - 2% 39% 10% - Atherstone North 64% 18% - - 18% - - Atherstone South & Mancetter 50% 7% 4% - 32% - 7% Combined Wards Total 49% 8% 1% 1% 34% 5% 2% Source: Mosaic, Warwickshire Priority Families Programme

Some key headlines for the Atherstone families attached to the Priority Families programme are provided below:

• 20% of the families have a child aged 0 to 4. This is slightly higher than the Warwickshire total, where 17% of the total families on the programme have at least one child aged 0 to 4 years. • Overall, over one third of children (39%) live with their family in social housing. This is higher than the overall figure for North Warwickshire Borough families attached to the programme where just under one third of families (31%) reside in social housing. • Almost one third (28%) of children live within a family where Income Support is being claimed. • Almost one third (28%) of children live within a family where Carers Allowance is being claimed. This is where benefits are claimed if someone within the family is caring for someone for at least 35 hours per week.

CHILDREN’S SOCIAL CARE

There are a number of key measures that Warwickshire County Council focuses on in relation to children’s social care. The Council aims to provide a responsive and seamless provision for children, young people and families in need of help and protection, to ensure they have access to the right support at the right time.

Under the Children Act 1989 a child is legally defined as looked after by a local authority if he or she gets accommodation from the local authority for a continuous period of more than 24 hours, is a subject to a care order or is subject to a placement order.

The number of children looked after (CLA) in Warwickshire has increased slightly over the past three years (4% increase). Within the three Atherstone wards, levels have reduced by 17.5% overall, however the small numbers result in large percentage changes (Figure 63). There are seven less CLA

72 in 2015/16 compared to 2013/14. Interrogating this data further reveals that Atherstone South & Mancetter is the only ward to have experienced an increase in the number of looked after children: an increase from five children in 2013/14 to 13 in 2015/16.

Figure 63: Total number of Children Looked After, Financial Year Totals, 2013/14 – 2015/16

% change 2013/14 2014/15 2015/16 (2013/14 to 2015/16) Atherstone Central 29 21 16 - 44.8% Atherstone North 6 3 4 - 33.3% Atherstone South & Mancetter 5 10 13 + 160% Combined Ward Total 40 34 33 - 17.5% Warwickshire 1,010 995 1,050 + 4% Source: Children’s Social Care, Insight Service, Performance Business Unit Note: The figures are based on the child's home address at point they were accommodated by the local authority and not the placement address.

Within Warwickshire, the most common placement type for a CLA is with a local authority foster carer (41%). This is also true when focusing on the three combined Atherstone wards. A snapshot at 31st January 2017 reveals that there were 22 CLA where their home address was in one of the three Atherstone wards at the point they were accommodated by the local authority. Of the 22 children, half (50%) were placed with a local authority foster carer and a further 27% were placed with an agency foster carer. Other placement types for children from these wards included being placed with family/friends (9%), being placed for adoption (9%) and within a residential establishment (9%). This is in line with the overall Warwickshire proportion.

Looking at the types of order, over half of the CLA (59%), where their home address was in one of the three Atherstone wards at the point they were accommodated by the local authority, were subject to a full care order and a further 18% subject to an interim care order. This is similar to the Warwickshire profile where just under half (48%) of CLA are subject to a full care order.

The aim of a Child Protection Plan is to ensure that the child is safe from harm and prevent him or her from suffering further harm, promote the child’s health and development and support the family to safeguard and promote the welfare of their child (provided it is in the best interests of the child).

Figure 64 shows the total number of children subject to a Child Protection Plan. The 5.5% reduction in the number of children subject to a Child Protection Plan in the combined three Atherstone wards is in line with the reduction seen across the county (6.3%). There is a variation when you focus down at ward level where only Atherstone North ward has experienced an increase. The number of children subject to a Child Protection Plan has almost doubled, increasing from nine in the financial year period of 1st April 2013 to 31st March 2014 to 16 in the corresponding period of 2015/16.

73 Figure 64: Total number of Children subject to a Child Protection Plan, Financial Year Totals, 2013/14 – 2015/16

% change 2013/14 2014/15 2015/16 (2013/14 to 2015/16) Atherstone Central 28 27 24 - 14.3% Atherstone North 9 11 16 + 77.8% Atherstone South & Mancetter 18 11 12 - 33.3% Combined Wards Total 55 49 52 - 5.5% Warwickshire 1,185 1,105 1,110 - 6.3% Source: Children’s Social Care, Insight Service, Performance Business Unit

In Warwickshire, of the children that were subject to a Child Protection Plan at 31st January 2017, the highest proportion had been on the plan between 0 to 3 months (28%). The profile for children living in the combined three Atherstone wards is slightly different and there are a higher proportion of children that have been on a plan for 3 to 6 months (41%), compared to 23% of Warwickshire children. There are also a higher proportion of children that have been on a plan for 1 to 2 years (32%), compared to the proportion of Warwickshire children (19%). Generally Atherstone children appear to spend longer on a Child Protection Plan compared to Warwickshire children.

Section 17 of the Children Act 1989 defines a Child in Need as a child who is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him/her of services; or a child whose health or development is likely to be significantly impaired, or further impaired, without the provision of services; or a child who is disabled.

Across Warwickshire there has been a 10.6% increase in the number of children subject to a Child in Need Plan (Figure 65). In the combined Atherstone wards, bearing in mind low numbers and large percentage increases, there has been a 93.9% increase in the number of children subject to Child in Need where figures almost doubled when comparing 2013/14 (66) to the corresponding period of 2015/16 (128). As this picture is quite different to the general Warwickshire picture it could be the result of a localised approach to social care cases.

A survey conducted by the organisation Community Care (http://www.communitycare.co.uk/) in September 2015, of 1,093 social workers in England revealed that 43% of practitioners said they had been ‘pressured’ to reclassify child protection cases as Child in Need, where Child in Need is a less serious category of cases which requires less intensive support. It is possible that the increase may be a result of allocating cases more appropriately but the survey revealed that 76% of social workers felt the moves were an attempt to reduce the number of child protection cases. As there has been an increase in the number of children subject to Child in Need living within the three Atherstone wards, it is recommended that the reasons for the local increase be investigated further in order to help understand the Atherstone increase.

74 Figure 65: Total number of Children subject to Child in Need, Financial Year Totals, 2013/14 – 2015/16

% change 2013/14 2014/15 2015/16 (2013/14 to 2015/16) Atherstone Central 38 66 66 + 73.7% Atherstone North 14 27 27 + 92.9% Atherstone South & Mancetter 14 32 35 + 150 % Combined Wards Total 66 125 128 + 93.9% Warwickshire 5,353 6,227 5,922 + 10.6% Source: Children’s Social Care, Insight Service, Performance Business Unit Note: Excludes children classified as ‘Looked After Children’ or those on a Child Protection Plan

ADULT SOCIAL CARE

From April 2015, care and support in England began to see changes. The first phase of the Care Act 2014 was implemented and the aim was to make care and support more consistent across the country. The national changes were designed to put the individual in control of the help that they receive with the ultimate aim of allowing people to stay healthy and remain independent for longer. Phase Two will follow in 2020 and the changes will see a provision of further financial help for those that need it and there will be a new form of protection from unlimited care costs.

One of the key measures that Warwickshire County Council looks at is the number of service users. This is split across three areas; residential, community and low level/preventative (Figure 66). In Warwickshire the highest proportion of service users (60%) are accessing community services but the proportion in the three Atherstone wards is higher at 70%. Community services include home care, day care, supported living, extra care housing and direct payments. Interestingly, there are less Atherstone residents accessing lower level and preventative services, which includes equipment, assistive technology and reablement (6%) compared to the general Warwickshire population of service users (15%). It may be that more meaningful community services are accessible by Atherstone service users in comparison to services which may be available at a lower level.

Figure 66: Total number and proportion of service users by service setting, January 2015 - December 2016 (2 years) Service Setting Warwickshire % of Total Atherstone Total % of Total Total Residential 46,781 25% 445 21% Community 115,358 60% 1,460 70% Low Level / Preventative 28,763 15% 184 6% Total 190,902 100% 2,089 100% Source: Adult Social Care, Insight Service, Performance Business Unit

75 Focusing on Atherstone, it is useful to look at the breakdown of service areas that users are accessing and compare it to the Warwickshire service user population. Figure 67 shows that in Atherstone wards, the highest proportion of service users access OIder People services (41%). When this is compared to county level service areas, this only accounts for 5% of the Warwickshire total, a significant difference when comparing Atherstone to the county. The Older People service area is a less specialised group and can vary between personal budgets to residential services to meals on wheels. Given Atherstone’s population profile, where in Atherstone North ward, 25% of the population is aged 65 years or older, the proportion of service users accessing older people services is not unexpected but is significantly higher than the equivalent Warwickshire figure.

Figure 67: Service Area Breakdown – January 2015 to December 2016 (2 years)

100%

80%

60%

40%

20%

0% Warwickshire Atherstone 2015 - 2016 2015-2016 Mental Health Older People's Mental Health (OPMH) Reablement Physical Disability Support Service (PDSS) Older People (OP) Occupational Therapy (OT) Hospital Other Learning Disability Source: Adult Social Care, Insight Service, Performance Business Unit

Learning Disability is another service area which is accessed by a significant number of Atherstone service users (24%) compared to 1% for total Warwickshire service users. In Warwickshire, the highest proportion of service users access mental health services (43%) which can be compared to just 2% in Atherstone. Given the high proportion of people who are referred to Older People services in Atherstone, the proportion of service users accessing Older People’s Mental Health (OPMH) services is low; one in five (20%) of the total Warwickshire service users are accessing this service compared to just 3% in Atherstone.

The primary support reasons for adult social care clients living in Atherstone are displayed in Figure 68. The primary reason which ranks the highest is access and mobility, which is an issue faced by the largest number of Atherstone clients, which correlates with the high proportion of people using

76 Older People services. Analysis revealed in Atherstone, the largest proportion of clients face issues with a physical long term health condition for which they seek support from social care services.

Figure 68: Primary Support Reasons for Adult Social Care Clients – Top Five

Rank Primary Support Reason 1 Access & Mobility Only 2 Personal Care Support 3 Support for Carer 4 Support with Memory & Cognition 5 Learning Disability Support Source: Adult Social Care, Insight Service, Performance Business Unit

The considerable difference in the service user profile for Adult Social Care users in Atherstone when compared to Warwickshire (Figure 67) may be worth further investigation to determine whether vulnerable groups in Atherstone have the right information, advice and access to the support they require, particularly in areas such as mental health and learning disabilities.

From April 2015, the Care Act changed the eligibility criteria so that everyone needed to be reassessed. This meant that there was a significant increase in the number of people receiving assessments of need for care and support. Over recent months, the focus has shifted with more reviews being carried out rather than assessments. Figure 69 shows the number of new assessments conducted across both Atherstone and Warwickshire. The lower numbers in Atherstone mean that the trend-line fluctuates.

It is also important to compare against the number of service users that have seen their service end within the same time period. This has also increased slightly within Warwickshire. There has been a 9.2% increase in service ends for Warwickshire service users when comparing the period January to December 2016 (4,494) to the corresponding period of 2015 (4,118). Atherstone has experienced a similar increase of 8.3% in the same period, an increase from 48 service ends in 2015 to 52 in 2016. In Atherstone the largest increase in service ends has been seen for those people accessing community based services but this links to a more general increase in overall access to community services in Atherstone by local people. Less people access low level and preventative services in Atherstone and the reduction in the number of service ends in this area reflects this.

77 Figure 69: New Assessments, January 2015 to December 2016 400 14 Warwickshire Atherstone 350 12 300 10 250 8 200 6 150 4 100 50 2 0 0

Source: Adult Social Care, Insight Service, Performance Business Unit

Safeguarding Concerns

Another measure that is included as an indicator for adult social care is safeguarding concerns and safeguarding enquiries. Information is collected on the number of concerns which are raised and enquiries which follow. Safeguarding concerns are where suspected signs of abuse are reported to, or have been identified by, Warwickshire County Council. Concerns can include cases of sexual exploitation, modern slavery, domestic abuse and self-neglect. Safeguarding enquiries are where action has been taken or has been instigated by Warwickshire County Council in response to a concern that abuse or neglect may be taking place.

Atherstone has seen a slight increase in the number of safeguarding concerns but small numbers mean large percentage increases. Levels increased from 48 in the period January to December 2015 to 52 in the period of 2016. This is consistent with the Warwickshire picture where a 7% increase was experienced. Only 2% of the safeguarding concerns received in Warwickshire and 2.1% of the safeguarding enquiries for Warwickshire concern the Atherstone area.

78 EDUCATION, EMPLOYMENT & INCOME

EDUCATION

For the purpose of this section, when analysing educational attainment data, disadvantaged children are defined as:

• those registered as eligible for free school meals at any point in the last six years • children looked after by a local authority • children who left care in England and Wales through adoption or via a Special Guardianship or Child Arrangements Order.

Other pupils are all pupils who are not disadvantaged.

Early Years Attainment

The Early Years Foundation Stage Profile (EYFSP) is a teacher assessment of children’s development at the end of Reception (pupils aged 4 or 5). It covers three prime areas of a child's development:

• communication and language • physical • personal, social and emotional development.

The EYFSP framework has been in place since September 2012 with the first set of results reported in July 2013. The main indicator for this assessment is Good Level of Development (GLD). Children achieving a GLD are those achieving at least the expected level in a number of identified learning areas.

In 2016, in Atherstone the gap between those children who are disadvantaged and those who are not in terms of school readiness is greater than North Warwickshire Borough as a whole (36%, compared to a borough average of 33%), and considerably more than the Warwickshire equivalent (21%) and national average (18%). Atherstone South and Mancetter ward has the largest gap at 45% (Figure 70).

Figure 70: Percentage of children achieving a Good Level of Development (school readiness)

2014 2015 2016 All Dis Other All Dis Other All Dis Other Atherstone Central 45% 25% 49% 63% 40% 67% 58% 43% 62% Atherstone North 48% 0%* 65% 44% 0%* 46% 66% 0%* 76% Atherstone South and 43% 20% 50% 46% 29% 50% 56% 22% 67% Mancetter Atherstone All 45% 16% 53% 52% 31% 55% 59% 30% 66% North Warwickshire 59% 39% 59% 60% 46% 67% 68% 39% 72% Borough Warwickshire 60% 39% 63% 67% 49% 70% 71% 52% 73% National 60% 45% 64% 66% 51% 69% 69% 54% 72%

79 * There are less than 6 disadvantaged pupils of Reception age in Atherstone North ward in 2014-2016

Figure 71 shows that according to the latest 2016 data, the ‘gap’ between those achieving a Good Level of Development who are disadvantaged and those who are not has increased from 2015. It is important to note that this is not due to the GLD levels falling for disadvantaged pupils, but the rise in GLD levels for other pupils in Atherstone.

Figure 71: The ‘gap’ in Atherstone (all wards) in GLD, 2016 (school readiness)

70% Disadvantaged pupils Other pupils 60%

50% 24% 36% 37% point gap point gap 40% point gap

Development 30%

pupils achieving a Good Level of Level Good a achieving pupils 20%

%

10%

0% 2014 2015 2016

End of Primary School Attainment – Key Stage 2

Pupils at the end of Key Stage 2 in 2016 were assessed against the new national curriculum. Results are no longer reported as levels and each pupil receives their test results as a scaled score and teacher assessments are based on specific standards. Due to these changes, figures for 2016 are not comparable to those for earlier years. The expectations for pupils at the end of Key Stage 2 have been raised and the national tests reflect this.

For Reading, Writing and Maths in 2016 in Atherstone, the gap between those children who are disadvantaged and those who are not is greater than North Warwickshire Borough as a whole (27% compared to 21% borough average) and greater than the county (25%) and national (22%) averages. Atherstone North ward has the largest gap at 44% (Figure 72).

80 Figure 72: Percentage of children achieving the Expected Level in each subject (2016)

Reading (R) Writing (W) Maths (M) RWM

All Dis Other All Dis Other All Dis Other All Dis Other Atherstone 42% 41% 42% 56% 41% 65% 56% 47% 62% 35% 29% 38% Central Atherstone 63% 33% 77% 87% 75% 92% 74% 50% 85% 55% 25% 69% North Atherstone South & 59% 22% 74% 59% 33% 70% 47% 22% 57% 44% 22% 52% Mancetter Atherstone All 54% 34% 64% 67% 50% 76% 59% 42% 68% 44% 26% 53% North Warwickshire 64% 49% 69% 77% 64% 81% 64% 47% 69% 50% 34% 55% Borough

Warwickshire 69% 51% 74% 77% 62% 82% 71% 52% 77% 57% 38% 63%

National 66% 53% 73% 74% 64% 79% 70% 58% 76% 53% 39% 61%

End of Secondary School Attainment – Key Stage 4

A new secondary school accountability system was implemented in 2016. The headline accountability measures for schools from 2016 are:

• Attainment 8 • Progress 8 • Attainment in English and Maths (A*-C) • English Baccalaureate (EBacc) entry and achievement

Attainment in the previous headline measure of 5+ A*-C including English and maths is no longer used as a key performance measure.

These new measures mean that there is no historical data for Attainment 8 or Progress 8.

Attainment 8 - measures the average achievement of pupils in up to 8 GCSE (or equivalent) qualifications including English, maths, three further qualifications that count in the English Baccalaureate (EBacc) and three other qualifications that can be GCSE or any other DfE approved non-GCSE qualifications.

Progress 8 - aims to capture the progress pupils make from the end of key stage 2 to the end of key stage 4. It compares pupils’ achievement – their Attainment 8 score – with the average Attainment 8 score of all pupils nationally who had a similar starting point (or ‘prior attainment’), calculated using assessment results from the end of primary school.

81 The English Baccalaureate (EBacc) - The EBacc was first introduced into the performance tables in 2009/10. It allows people to see how many pupils get A* to C or above in core academic subjects. The EBacc is made up of English, maths, science, a language, and history or geography. To count in the EBacc, qualifications must be on the English Baccalaureate list of qualifications.

For Attainment 8 in 2016 in Atherstone, the average score gap between those children who are disadvantaged and those who are not is greater than the North Warwickshire Borough figure (15.8 compared to 12.4), and greater than Warwickshire (14.6) and the national average (12.3). Atherstone South and Mancetter ward has the largest gap at 19.1 (Figure 73).

Figure 73: Students achieving the new Key Stage 4 measures (2016)

Attainment 8 % A*-C in English & % achieving the (average score and Progress 81 Maths EBACC grade) All Dis Other All Dis Other All Dis Other All Dis Other Atherstone 44.8 35.7 48.0 54% 20% 66% 8% 10% 7% -0.16 -0.45 -0.06 Central D+ D- C- Atherstone 54.4 45.3 55.6 76% 25% 83% 24% 0% 28% 0.09 0.16 0.08 North C+ C- B- Atherstone 42.3 28.3 47.4 South and 47% 13% 59% 17% 0% 23% -0.13 -0.56 0.03 D+ E C- Mancetter 47.2 34.8 50.6 Atherstone All 59% 18% 70% 16% 5% 19% -0.07 -0.38 0.02 C- E+ C North 48.2 38.6 51.0 Warwickshire 55% 32% 62% 21% 6% 25% -0.11 -0.47 -0.57 C- D C Borough 52.2 40.4 55.0 Warwickshire 67% 41% 73% 29% 9% 34% 0.02 -0.46 0.13 C+ D B- 50.1 41.2 53.5 National 63% 43% 71% 25% 12% 30% -0.03 -0.38 0.10 C D C+ 1 - The national average Progress 8 score for mainstream schools is 0. The greater the Progress 8 score, the greater the progress made by pupils compared to the average of pupils with similar prior attainment.

• A score of zero means pupils on average do about as well at key stage 4 as other pupils across England who got similar results at the end of key stage 2.

• A score above zero means pupils made more progress, on average, than pupils across England who got similar results at the end of key stage 2.

• A score below zero means pupils made less progress, on average, than pupils across England who got similar results at the end of key stage 2.

82 From September 2016 The Department for Education (DfE) changed the requirement for Local Authorities’ tracking of young people. They reduced the requirement from tracking all young people up to the end of the academic year they turned 19 to tracking all young people up to the end of the academic year in which they turn 18. It is not possible to compare new NEETs (a young person who is "Not in Education, Employment, or Training”) figures to historic data. Figure 74 gives a snap shot in time. The number of NEETs varies considerably at different times of the year, for example, it peaks after young people finish school. Atherstone young people make up around a third to a half of North Warwickshire Borough’s NEETs, with a similar proportion in the Not Known category (proportions imprecise as a result of data suppression due to confidentiality).

Figure 74: NEETs/Not Known (16 and 17 year olds only)

As at 31st December 2016

NEETS Not Known Atherstone Central 6 26 Atherstone North <5 <5 Atherstone South & Mancetter 6 <5 North Warwickshire Borough 36 73 Warwickshire 267 439 Source: Prospects, commissioned by the Local Authority to track and report to the DfE the status of all young people in academic years 12 and 13

Schools in Atherstone

There are 5 schools in Atherstone; 1 Nursery, 3 Primary schools and 1 Secondary school (Figure 75). Two of the three primary schools in Atherstone require improvement. Children in Atherstone receive an outstanding early years education experience, which is not matched when they start school.

Figure 75: Schools in Atherstone, January 2017

January 2017 School Numbers Ofsted Ofsted Inspection Education Type on Roll1 Inspection Date2 Grade2 Atherstone Nursery School 75 26/11/2014 1 - Outstanding LA Nursery School 3 – Requires Outwoods Primary School 418 05/03/2015 Community School Improvement 3 – Requires Academy Sponsor Racemeadow Primary Academy 238 05/06/2015 Improvement Led St. Benedict's Catholic Primary Academy 183 23/11/2012 2 - Good School Converter Academy Sponsor The Queen Elizabeth Academy 551 09/05/2017 2 - Good Led Total 1,465 1 – Source: January 2017 School Census

83 2 – Source: DfE statistics website as at 31/01/2017: https://www.gov.uk/government/statistical-data- sets/monthly-management-information-ofsteds-school-inspections-outcomes

Outwoods Primary School is the only Local Authority maintained school. There is no direct involvement with the academies from a local authority point of view, although the academies are able to access relevant training from the local authority. All schools are also able to access support via their consortium. The Learning and Performance Team within Warwickshire County Council are exploring the possibility of Outwoods Primary School joining a consortium which has a better balance of maintained schools and academies. The academies are subject to their own academy regulatory responsibilities and internal school improvement accountabilities.

Outwoods Primary School is identified by the Department for Education as a ‘coasting school’ and as a result, is receiving support from a Warwickshire County Council officer in order to address this. The school also receives regular task group meetings in order to support and monitor the progress that the school is making as an Ofsted ‘Requires Improvement’ school.

Pupils eligible and claiming Free School Meals (FSM)

Entitlement to free school meals is determined by the receipt of income related benefits, therefore it is linked to the performance of the labour market. As the number of benefit claimants decrease, the proportion of pupils eligible for free school meals also falls.

There is a higher percentage of children attending schools in Atherstone who are eligible for free school meals than North Warwickshire Borough and Warwickshire (Figure 76). This is particularly the case in Outwoods Primary School and Racemeadow Primary Academy.

Figure 76: Number and percentage of pupils claiming Free School Meals

January 2014 January 2015 January 2016 Schools No. % No. % No. % Atherstone Nursery School n/a n/a 8 9% n/a n/a Outwoods Primary School 96 25% 66 17% 64 16% Racemeadow Primary Academy 41 18% 33 15% 34 15% St. Benedict's Catholic Primary School 12 8% 8 5% 18 10% The Queen Elizabeth Academy 70 13% 57 11% 60 12% January 2014 January 2015 January 2016 Schools No. % No. No. % Atherstone (based on the schools above) 219 16% 172 12% 176 13% North Warwickshire Borough 1065 10% 954 10% 939 9% Warwickshire 7611 10% 6904 9% 6703 9% National 1,266,035 16% 1,198,494 15% 1,145,199 14%

84 30% Jan-14 Jan-15 Jan-16

25%

20%

15%

10% % of pupils claiming FSMs claiming pupils % of

5%

0% Outwoods Racemeadow St. Benedict's The Queen Atherstone North Warwickshire National Primary School Primary Catholic Primary Elizabeth (based on the Warwickshire Academy School Academy schools above) Source: January School Census

Breakfast Club & Food Hub

The Queen Elizabeth Academy run a daily breakfast club that is free and open to all users. Students arrive from 7.40am in the morning and they are provided with a warm and supervised area as well as a breakfast. The club provides breakfast to between 25 and 35 students most mornings (this is different students on different days). It is difficult to estimate how many of the students using this facility are eligible for free school meals, however nine families classified as vulnerable frequently attend.

There is also a group (five families) who attend as their parents go to work early on some or all days. Many of the teaching staff have commented on the advantages of engaging with students in a more informal environment and that it has helped with staff / student relationships.

The breakfast club is supported by the Food Hub (formerly the Food Bank) with breakfast supplies. The club’s fareshare membership provides around 33% of funding and the Food Hub 25%; the rest is sourced from the school’s own funds. Some costs are offset by using food from the Food Hub in some lessons, freeing up these funds for breakfast club.

The school’s biggest use of Food Hub supplies is to support the curriculum through the provision of ingredients for food and nutrition lessons for students eligible for free school meals or with other difficulties. In many other schools they would be discouraged from taking the subject as the

85 provision of ingredients would be an issue; because of the Food Hub support the school can be completely inclusive.

There is evidence to suggest that the provision of food from the Food Hub has a positive impact on educational attainment at the Queen Elizabeth Academy.

Pupil absence

Regular school attendance is an important part of giving any child the best possible start in life. Going to school regularly is important for a child's future, for example, children who miss school can often fall behind with their work and do less well in exams. Good attendance shows potential employers that a child is reliable. Research suggests that children who go to school regularly could also be at less risk of getting involved in anti-social behaviour or crime.

The Department for Education (DfE) uses two key measures to monitor pupil absence - overall and persistent absence. The overall absence rate is the total number of overall absence sessions for all pupils as a percentage of the total number of possible sessions for all pupils, where overall absence is the sum of authorised and unauthorised absence and one session is equal to half a day.

Pupils are identified as persistent absentees by comparing the number of overall absence sessions they have against a standard threshold of around 15% of possible sessions, equating to 56 or more sessions across the full academic year for pupils aged 5 to 14 and 46 or more sessions across the full academic year for pupils aged 15.

Please note that from the start of the 2015/16 academic year, following a change in the persistent absence definition and methodology by the DfE, a pupil has been classified as a persistent absentee if they miss 10% or more of their own possible sessions, rather than if they reach a standard threshold of absence sessions. This means that if a pupil's overall absence rate is 10% or higher they will be classified as persistently absent.

Atherstone schools’ absence rate is in line with that of North Warwickshire Borough as a whole and Warwickshire as a county. Figure 77 reports the overall absence rate and the persistent absence rate based on the 15% threshold definition. Future statistics will report on the new definition as outlined above.

Figure 77: Overall and Persistent rates of absence

2013/2014 2014/2015 2015/2016 School Area PA PA PA Overall Overall Overall (15%) (15%) (15%) Not applicable – absence data is not collect from nursery Atherstone Nursery School schools Outwoods Primary School 5% 3% 5% 4% 5% 4% Racemeadow Primary Academy 4% 0% 4% 2% 5% 4% St. Benedict's Catholic Primary School 4% 1% 4% 3% 5% 3% The Queen Elizabeth Academy 6% 3% 6% 6% 5% 5%

86 Atherstone (based on the schools above) 5% 2% 5% 4% 5% 4% North Warwickshire Borough 4% 3% 5% 3% 5% 5% Warwickshire 4% 4% 4% 3% 4% 4% Not yet published National 5% 4% 5% 4% (due mid 2017) Source: School Census

Educational places planning

Existing pupil forecasts show that without further housing development there will be sufficient capacity in schools in the Atherstone area.

North Warwickshire Borough Council’s Draft Local Plan outlines 5,280 new homes across the borough over the next 15 years. These new homes will be primarily distributed across the main market towns and local population centres and allocations include close to 2,000 dwellings in the Atherstone and Mancetter area. Warwickshire County Council estimates this could generate just less than an additional 300 primary school age children and around 200 secondary school age children.

Current primary schools in the area have some available capacity to accommodate these additional children but a new primary school may be needed to serve development to the north of Atherstone town.

Atherstone has one secondary school, The Queen Elizabeth Academy that has recently been rebuilt under the Governments’ Priority School Building Programme. It is likely that this school would need to be expanded in order to accommodate additional children generated a result of the proposed development.

EDUCATION, SKILLS AND TRAINING DEPRIVATION

Part of the 2015 Indices of Multiple Deprivation (IMD) looks specifically at attainment and skills in the local population. The measure is composed of two elements: one relating to education deprivation for children/young people in the area and the other looking at the skills and qualifications among a sub-set of the working age adult population.

There is considerable variation both between the areas in Atherstone and the area appears to rank more poorly on the education, skills and training domain compared to the overall deprivation rankings i.e. more areas are in the top 10% most deprived nationally on the education, skills and training rank than the overall index.

Mancetter South and Ridge Lane LSOA is ranked in the top 10% most deprived areas nationally. Atherstone Central – Centre LSOA and Atherstone North – St. George and Carlyon LSOA are also both ranked in the top 10% most deprived areas nationally for education, skills and training and are relatively more deprived on this measure than their overall IMD ranking.

87 Atherstone Central – Canal and Outwoods LSOA is in the top 30% most deprived areas in the country for education, skills and training deprivation. Atherstone South, Mancetter North and Atherstone North – Town Centre North & Alder Mill LSOA are also ranked lower for education, skills and training than their respective IMD rankings (Figure 78).

Figure 78: Education, Skills & Training Deprivation (2015)

Source: Department of Communities and Local Government

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EMPLOYMENT & THE ECONOMY

Understanding an area and its local economy is crucial in analysing current economic performance and developing effective plans for future growth and development. In recent times, the economy across the sub-region has seen a significant continued reduction in employment and activity within the manufacturing sector, and strong growth in business & financial services, transport and logistics, construction, and public services (particularly health and education).

Business base

In 2016, Bureau van Dijk reported that there were 1,177 businesses located in the three wards of Atherstone Central, Atherstone North and Atherstone South & Mancetter. The highest numbers of businesses are located in Atherstone Central ward (565), the second highest are in Atherstone North ward (402) and Atherstone South & Mancetter has the lowest number (210). Due to the town nature of Atherstone Central it is not unexpected that this ward would have the highest number of businesses as it is home to a number of retail premises, pubs, supermarkets and other businesses.

In North Warwickshire Borough, the Business Register and Employment Survey for 2015 reveals that the industries which employ the largest number of people are in:

• Wholesale and Retail Trade industry (8,072 employees) • Transportation and Storage (8,764 employees).

Focusing on the three Atherstone wards, there are three industries employing the highest proportion of Atherstone residents (Figure 79). The Transportation & Storage industry employs the most people (2,077) and has also experienced an increase of 24% when comparing 2015 figures to the number of employees in 2012. The industry which has seen the largest increase is the Professional, Scientific and Technical Activities industry which has increased from 945 employees in 2012 to 1,581 in 2015, an increase of 67%.

By comparison the industries which have experienced the biggest decline in the number of employees which are resident in Atherstone are the Financial and Insurance Activities industry (44.3% reduction) and the Education industry (37.9% reduction) (Figure 80).

Figure 79: Number of people employed by top 3 industries employing Atherstone residents

2012 2015 % Change (2012-2015) C: Manufacturing 1,332 1,315 - 1.3% H: Transportation & Storage 1,681 2,077 23.6% M: Professional, scientific and technical activities 945 1,581 67.3% Source: Business Register and Employment Survey for 2015

Figure 80: Number of people employed by industry – top 3 industries employing Atherstone residents showing the largest decline in the number of employees

89

2012 2015 % Change (2012-2015) K: Financial and insurance activities 70 39 - 44.3% P: Education 330 205 - 37.9% E: Water supply; sewerage, waste management 20 13 - 35.0% and remediation activities Source: Business Register and Employment Survey for 2015

Interestingly, in 2015, the industries employing the most part-time employees are different across the three wards. In Atherstone Central and Atherstone South & Mancetter wards the highest proportion of part-time people are employed within the Wholesale and Retail trade, which may not be a surprise due to the high number of retail premises located in the centre of Atherstone town and surrounding area.

In Atherstone Central ward, 16% of residents are employed part-time in this industry and in Atherstone South & Mancetter ward 15% are employed in this way. In Atherstone North ward the highest proportion of part-time people are employed in the Transportation & Storage industry (5%) which may be due to the concentration of industrial units in the north of the ward.

Figure 81 shows the distribution of businesses across the three Atherstone wards. The data for all businesses in Atherstone has been mapped by postcode. The main concentration of businesses is in Atherstone Central ward, Atherstone North ward and also to the north of Atherstone South & Mancetter ward.

Apprenticeships

When focusing on employment it is also useful to look at the number of apprenticeships. Many industries have taken on young apprentices which mix on the job training with classroom learning. One of the benefits to young people is the chance to learn while they earn and they can provide a young person with the skills they need for their chosen career alongside gaining nationally recognised qualifications. The Labour Insight tool provides data on apprenticeships.

There has been a large increase in the number of apprenticeships that are in operation in Atherstone. Unfortunately it is not possible to split the data down by ward but collective data for Atherstone reveals a large increase over the past five years.

90

Figure 81: Atherstone businesses

© Crown Copyright and database right 2017. Ordnance Survey 100019520. Source: Economy & Skills Group, Warwickshire County Council

In the period April 2012 to March 2013 there were only 7 apprenticeships in operation across the three wards. By 2013/14 this had increased significantly to 24 and by 2016/17 the number was 34 (Figure 82).

The highest number of apprenticeships was for roles such as:

• Sales Executives (9%) • Retail Assistants (9%) • Customer Relations staff (9%)

The roles appear much more spread across the different industries, where in 2012/13 a large number of the apprenticeships were IT Technician related. In 2016/17 new roles have emerged which align to the fast paced development of the IT world, for example, Social Media and Digital Marketing Apprentice and Web Development Technician roles.

91

Figure 82: Top Categories for Apprenticeship Roles in Atherstone (all wards)

Apprenticeship Roles Number of Apprenticeships 2016/17 Sales Executive 3 Retail Assistant / Sales Person 3 Customer Relations 3 Agriculture 2 Laboratory Technician 2 Accounts / Finance 2 Information Technology 2 Software & Web Development 2 Source: Labour Insight

Unemployment & Benefit Claimants

Whilst there are a high proportion of people employed within the three wards there is still a proportion of people that are unemployed and without work. A primary measure of unemployment is the claimant count, which measures the number of people claiming benefits principally for the reason of being unemployed (combining the number of people claiming Jobseeker’s Allowance (JSA) and National Insurance credits with the number of people receiving Universal Credit principally for the reason of being unemployed). Figure 83 shows the claimant count trend over the past four years.

Figure 83: Claimant Count, by ward, 2013 to 2016

80 Atherstone Central Ward Atherstone North Ward Atherstone South & Mancetter Ward 70

60

50

40

30 Number of Claimants of Number 20

10

0 2013 2014 2015 2016 Source: Office for National Statistics

When combining the three wards, the claimant count trend experienced an increase in 2016 and at December reported 110 claimants of benefits principally for the reason of being unemployed. Atherstone Central ward has the highest level of claimants, with 65 claimants at December 2016.

92

Focusing on the Job Seeker’s Allowance benefit, at December 2016 there were a very low number of people claiming Job Seeker’s Allowance in the three Atherstone wards. The level has been reducing over the past three years and the primary reason for the reduction is the change to Universal Credit.

Across the three wards there were a total of 65 Job Seeker’s Allowance claimants, with the highest number recorded as residents of Atherstone Central ward (36 claimants). The current proportion of resident population aged 16 to 64 years currently claiming Job Seeker’s Allowance is highest in the Atherstone Central ward with a rate of 1.3% and is followed by Atherstone North and Atherstone South & Mancetter wards which both have rates of 0.7%. This is a reduction from rates recorded in December 2014 of 0.4% for Atherstone Central, 0.2% for Atherstone North and 0.1% for Atherstone South and Mancetter ward. At December 2016, in North Warwickshire Borough, there were 240 people claiming Job Seeker’s Allowance. Almost one third of JSA claimants (27.1%) live within the three wards of Atherstone Central, Atherstone North and Atherstone South & Mancetter.

When looking more closely at Job Seeker’s Allowance claimant data there is considerable variation between age groups claiming JSA in Atherstone North ward. The 50-65 age group consistently had the lowest number of claimants in the ward and went almost a year with no claimants, May 2015 to April 2016. The 16-30 and 30-49 age groups had similar levels of claimants throughout the three year period.

In Atherstone Central ward, the number of claimants peaked in the 30-49 age group with 50 claimants, which was the highest out of all three wards. In Atherstone South and Mancetter ward, all three age groups experienced slight declines in the 2013/14 financial year and remained generally steady for the following two financial years.

It is important to also look at the number of people claiming worklessness benefits to understand the full picture of those residents in Atherstone who are not expected to be working. The levels have reduced over the past five years with the largest reduction in the number of claimants seen in both Atherstone Central ward (21%) and also Atherstone South and Mancetter ward (21%). It must be noted that this reduction is mostly due to the move to Universal Credit for some claimants.

Figure 84 provides a current snapshot of worklessness data and shows the highest number of claimants being resident in the Atherstone Central ward (400). In fact, one quarter of all North Warwickshire Borough worklessness benefit claimants live within the three Atherstone wards (25.6%). It is particularly high for claimants of ‘others on income related benefits’ (includes pension credit claimants) where 33.3% of the total North Warwickshire Borough claimants are resident in the three Atherstone wards. Please note that the JSA figures referenced below are different to the ones included above as they have been extracted from a different dataset. The table is provided to help show the breakdown of worklessness benefit claimant data, for which JSA is one of the statistical groups.

Figure 84: Worklessness Benefit Claimants Breakdown, November 2016

Total Job ESA & Lone Carers Others Disabled Bereaved Claimants Seekers Incapacity Parents Atherstone Central 400 40 220 45 60 10 25 0

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Atherstone North 245 15 145 10 50 5 15 5 Atherstone South 275 15 145 25 60 5 20 5 & Mancetter Total 930 90 505 90 155 20 65 5 Source: NOMIS, September 2017

Universal Credit is claimed by people that are on either a low income or are out of work and it has replaced traditional benefits such as Job Seeker’s Allowance, Employment Support Allowance, Income Support, Child Tax Credit, Working Tax Credit and Housing Benefit. The benefit is paid once per month into an account and anyone with a partner will receive a single payment that covers both people. The change to Universal Credit has been occurring over the past twelve months and gradually numbers have been increasing. The provisional figures at December 2016 show that there are 86 claimants of Universal Credit living in the three Atherstone wards with almost half of the claimants (48%) living in the Atherstone Central ward. This is a large increase when compared to December 2015 when there were only 5 Universal Credit claimants living in the three wards and the benefit was first being implemented in North Warwickshire Borough. It also not surprising that Citizen’s Advice North Warwickshire experienced an increase in advisory sessions specifically on Universal Credit when it was first implemented, an increase from 0 to 22 sessions for the three Atherstone wards combined.

Figure 85 shows that over a two year period, in Atherstone the rate of disability living allowance claimants, per 100,000 0-65 aged population, has fallen slightly in all three wards of Atherstone.

Despite the falls, the rates in the three wards in Atherstone are considerably higher than the Warwickshire county level rates. The highest rates have been seen consistently in Atherstone North ward, with numbers ranging from 245 claimants in May 2014, falling to 220 by February 2016. The lowest rates of claimants were in Atherstone Central ward, which in terms of numbers had the highest number of claimants, with 285 claimants in May 2014, falling to 240 by February 2016. However, Atherstone Central ward also has the largest population of the three wards in Atherstone, which means the rates per population are lower than the other two wards.

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Figure 85: Disability Living Allowance Claimants, 2014 to 2016

10000

8000

6000

4000 Number of of Number claimants 2000

0 May 2014 August 2014 November February May 2015 August 2015 November February 2014 2015 2015 2016

Atherstone Central Atherstone North Atherstone South & Mancetter Warwickshire

Source: Nomis

North Warwickshire Borough Council Tenants

North Warwickshire Borough Council holds data on tenants living in Borough Council accommodation. At March 2017 there were 969 claimants of housing benefits living in the Atherstone and Mancetter area in council owned properties. Of the claimants, one third are also claiming child benefits (33%). In relation to work related benefits, 21.2% of claimants are either claiming Employment Support Allowance or are claiming Job Seekers’ Allowance.

There are a significant proportion of tenants also claiming Disability Living Allowance (30.4%) with a further 10% claiming Personal Independence Payments (PIP) which is a combined total of 40%. Many of these claimants are disabled and are likely to have mobility issues or have long term ill health issues.

Advice & Support

Citizen’s Advice Bureau (CAB) North Warwickshire provides advice to members of the community on a range of issues. Within the three Atherstone wards the main area of concern for residents around debt advice has been council tax arrears and 127 advisory sessions were held to give advice on this in the period April 2016 to March 2017. Over half of these sessions (56%) requested were from residents of Atherstone Central ward.

The second highest debt concern issue for residents of these three areas was rent arrears, where 84 advisory sessions were held in 2016/17. Interestingly, Atherstone North ward residents were most concerned about fuel debts and 33 advisory sessions were held by the Citizen’s Advice Bureau for Atherstone North ward residents concerned with this issue.

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There was also an increase in the number of advisory sessions held on fuel debt for both Atherstone North and Atherstone Central wards when comparing the period April 2016 to March 2017 to the same period of 2015/16. The number of sessions doubled from 33 to 70 for the two wards.

It is recommended that the area of fuel debt issues be explored further to help understand the reasons why fuel debt is becoming of increasing concern to Atherstone residents.

Overall, Citizen’s Advice Bureau North Warwickshire Borough have recorded that the highest number of advisory sessions for debt advice within the three wards has been for Atherstone Central ward which saw 322 advisory sessions held in 2016/17. 569 sessions were held for residents living in the three Atherstone wards.

The highest number of advisory sessions held by Citizen’s Advice Bureau North Warwickshire was for benefit advice. In the period April 2016 to March 2017, 600 advisory sessions were held for residents of the three Atherstone wards (Figure 86). The benefit that residents were most seeking advice on was Employment Support Allowance (83 sessions). This differs for residents of Atherstone Central ward where the benefit issue of most concern to them was ‘housing benefit’.

Figure 86: Citizen’s Advice Bureau – Five Themes from Benefit Advice Sessions, April 2016-March 2017

Atherstone Atherstone Atherstone Total Central North South & Mancetter Employment Support Allowance 33 22 28 83 Housing Benefit 53 14 8 75 Personal Independence Payment 38 11 20 69 Other Benefit Issues 38 16 11 65 Working & Child Tax Credits 34 18 12 64 Source: Citizen’s Advice Bureau North Warwickshire Borough, February 2017

Poverty

Across Atherstone there are families living in poverty. Data from HM Customs & Revenue reveals that there are some areas of the Atherstone wards which have a high proportion of children living in low-income families. Figures showing Personal Tax Credit data from August 2013 reveal that there are two Lower Super Output Areas (LSOA) in Atherstone which have a high proportion of children living within low-income families (Figure 87). Over one third (35%) of children living in the Mancetter South & Ridge Lane LSOA are in a low-income family and almost one third (30.9%) of children living in the Atherstone Central – Centre LSOA. The proportions in the other LSOAs are much lower.

Figure 87: Children in Low-income Families, Personal Tax Credits, Snapshot at 31st August 2013, by Lower Super Output Area

% of Children in Low-income Families (All Children) Mancetter South & Ridge Lane 35.0%

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Atherstone Central – Centre 30.9% Atherstone North – St George's & Carlyon 17.8% Atherstone Central – Canal & Outwoods 13.7% Atherstone South 5.5% Mancetter North 5.5% Atherstone North – Town Centre & Alder Mill 5.2% Source: HM Revenue & Customs, Personal tax credits: Children in low-income families local measure

This is further supported by data made available by the Department for Work & Pensions (DWP) which provides figures on the number of children living in out of work benefit claimant households.

At May 2015 there were 200 families living across the three Atherstone wards in out of work benefit claimant households. The highest number of these families live within the Mancetter South & Ridge Lane LSOA (65 families) and Atherstone Central – Centre LSOA (55 families).

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CRIME & COMMUNITY SAFETY

Crime and ASB are often at the forefront of public concern and can have a significant impact on a person’s quality of life. The 2015 Quality of Life report identified that although general levels of crime in Warwickshire are low, the fear of crime remains high. A positive correlation was identified between fear and actual crime levels.

Included in this report is an overview of crime and ASB for the three examined wards. For further analysis on the breakdown of offences and top crime categories a full supporting report is available on request from Warwickshire County Council Research Team, please email [email protected] to request a copy.

Crime and Anti-Social Behaviour (ASB) Overview

During 2016, across the three Atherstone wards there were a total of 968 criminal offences and 491 ASB incidents reported.

Figure 88 provides the breakdown by ward and also examines the crime and incident rate per 1,000 population. All three wards have a crime rate above both the borough and county average. Atherstone Central Ward has the highest rate by a significant margin, however this is not unexpected given that the ward includes Atherstone Town Centre and is the location for the main commercial and licensed premises.

Note: Location and offence/incident data has been kept deliberately vague and/or has been anonymised so as individual places/people cannot be identified.

Figure 88: Crime & ASB incidents by ward, January to December 2016

Population Total Total crime Total ASB Total ASB rate (mid-2015 criminal rate per incidents per 1,000 estimate) offences 1,000 population population Atherstone Central 4,150 492 118.55 228 54.94 Atherstone North 3,437 227 66.05 92 26.77 Atherstone South & 3,679 249 67.68 171 46.48 Mancetter

North Warwickshire 62,787 4,070 64.82 2,075 33.05 Borough Warwickshire 554,002 35,563 64.19 17,206 31.06 Sources: Crime Information System, STORM Incident System, Warwickshire Police. ONS mid-2015 population projections

Figure 89 lists the ASB incident levels by category for the 12 month period January to December 2016 by ward.

Figure 89: ASB incidents by category, January – December 2016

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ASB Category Nuisance Personal Environmental Total incidents Atherstone Central 168 46 14 228 Atherstone South & Mancetter 98 53 20 171 Atherstone North 64 22 6 92 Total incidents (%) 330 (67%) 121 (25%) 40 (8%) 491 Source: STORM Incident System, Warwickshire Police

The Warwickshire split for ASB incidents is nuisance 70%, personal 20% and environmental 10% - this differs in Atherstone wards with a higher proportion of personal incidents. The personal incident figure for Atherstone South & Mancetter ward of 53 is equivalent to 31% of total ASB for the ward which is proportionately high. Personal ASB involves the targeting of individuals (for example neighbour disputes) and is the highest priority ASB category due to the risk of there being vulnerable victims.

Crime

Analysis of crime across the three wards during 2016 revealed the following key points:

Atherstone Central ward (total of 492 offences)

• Shoplifting accounts for more than a fifth of total offences, 96% of shoplifting offences took place on two streets (Long Street – 85 offences, Station Street – 21 offences). • ‘Common assault and battery’ and ‘assault occasioning actual bodily harm’ offences were the second and third highest crime categories by volume, with 57 and 48 offences respectively. Two locations in particular had a high volume of offences however in both cases the majority involved single incidents with multiple victims which were recorded as multiple offences. Both locations involved provision of care to vulnerable individuals and involved staff members being struck by residents. • A total of 72 offences in the ward out of the total of 492 (15%) involved alcohol and/or drugs.

Atherstone North ward (total of 227 offences)

• The top offence category was ‘other thefts not covered elsewhere’ (26 offences), on examination this was found to include a wide range of theft offences such as theft of artificial flowers, mobile phones, handbags, lead (including four thefts of lead flashing), fence panels and charity boxes. • The majority of these ‘other thefts’ appear to be mostly opportunistic thefts of fairly low value items except for the theft of lead flashing which appears more organised and targeted. • A total of 33 offences out of the total of 227 (15%) involved alcohol and/or drugs.

Atherstone South & Mancetter ward (total of 249 offences)

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• A third of offences (33%) consisted of ‘assault occasioning actual bodily harm’, ‘common assault and battery’ and ‘other thefts not covered elsewhere,’ each of which accounted for 28 offences. • ‘Other thefts not covered elsewhere’ included theft of parcels, tools, lead flashing (6 offences) and flowers and alcohol. As with Atherstone North ward, the thefts of lead flashing appear more organised and targeted than other thefts. • A total of 41 offences out of the total of 249 (17%) involved alcohol and/or drugs.

Victims and Offenders

Figures 90 and 91 illustrate the age and gender breakdown for victims and offenders for the examined period (January – December 2016, all three wards combined). The solid colour bars indicate the number of individual victims/offenders and the outline colour bars show the total number offences for which a victim or offender was identified. For example, in Figure 90, there were 62 individual female victims in the 20-29 age group who were victim of a total of 87 offences. This therefore indicates that some of the 62 victims were targeted for more than one offence during the examined period.

There were 572 individual victims named (303 male and 269 female) who had been victim of a total of 700 offences. There were 71 victims (12%) who had been a victim of more than one offence. The highest number of repeat offences against a single individual during the examined period was nine. Within the repeat victims there are examples of vulnerable adults being taken advantage of both financially and psychologically. Vulnerability is currently a priority theme for Warwickshire and West Mercia Police across all crime types.

The 20-29 age group has the highest proportion of victims for both males and females. The two most common offence types which males and females fell victim to, were assault occasioning actual bodily harm and common assault and battery. For victims aged 60+ the most common offence types included domestic burglary and ‘other thefts not covered elsewhere’ many of which involved the theft of lead.

Females were more likely to be a victim of multiple offences, compared to males for the majority of age groups. The most targeted female age group for repeat offences were the 20-29 year olds who were victim of an average of 1.4 offences.

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Figure 90: Age and gender of victims of crime (Jan-Dec 2016)

80+ Male Victims Female Victims 70-79 Offences with a male victim 60-69 Offences with a female victim

50-59

40-49

30-39

20-29

10-19

0-9

100 80 60 40 20 0 20 40 60 80 100 Number of victims/offences with an identified victim Source: Crime Information System, Warwickshire Police

Figure 91: Age and gender of offenders (Jan-Dec 2016)

60+ Male Offenders 50-59 Female Offenders Offences Committed by Males Offences Committed by Females 40-49

30-39

20-29

10-19

0-9

30 20 10 0 10 20 30 40

Number of Offenders/Offences Source: Crime Information System, Warwickshire Police

There were a total of 116 individual offenders named (90 male and 26 female) of which 27 (23%) committed more than one offence. Two female offenders committed 10 offences each during the examined period which was the highest number of offences by an individual offender. The offender

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data by age group reveals that offenders up to age 29 are mostly committing violent crime, shoplifting and drug related offences. More than half of the offences committed by those aged 30- 39 were shoplifting. Shoplifting is also the most common offence type for those aged 40 to 59 however the number of offenders tails off significantly from age 40 onwards

Comparing the number of offences committed to the number of offenders it is apparent that for females in particular, a small number of offenders have been responsible for a much larger volume of offences. For example, on average, female offenders in the 30-39 age group committed 2.9 offences per offender compared to 1.4 offences per offender for males of the same age.

Anti-Social Behaviour

The monthly total number of ASB incidents by ward for the period April 2013 to December 2016 show that both Atherstone Central and Atherstone North wards have seen a gradual reduction in incidents during this period whereas Atherstone South & Mancetter ward has seen an increase.

The overview section picked up on the relatively high proportion of ‘personal’ ASB cases for Atherstone South & Mancetter ward and consultation with Community Safety Partnership (CSP) representatives revealed that there are a number of case management plans relating to Mancetter which are considered at monthly case management meetings. These meetings also pick up repeat victims and individuals that may need extra support.

ASB is strongly influenced by seasonality, with the highest number of incidents generally taking place in the warmer summer months. Figure 92 provides the total ASB average for each month during the period April 2013 to December 2016. The darkest red figures represent the highest average number of incidents.

Figure 92: Seasonality of ASB incidents, average by month, April 2013 - December 2016

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Atherstone Central 19 15 18 18 21 24 21 25 17 15 14 13

Atherstone North 8 6 12 14 11 15 13 12 8 15 12 8

Atherstone South & 7 8 12 13 12 14 15 15 16 17 6 12 Mancetter

Source: STORM Incident System, Warwickshire Police

During the examined period there were seven Deliberate Small Fires (DSF) recorded by Warwickshire Fire and Rescue Service. Four took place in Atherstone North ward and three in Atherstone South & Mancetter ward.

While crime and ASB figures provide a good overview of the types of crime and incidents experienced in an area, the data is reliant on offences having been reported and therefore will only

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ever show part of the picture. Analysis by Warwickshire and West Mercia Police revealed that alliance wide they respond to five incidents to every one recorded crime. In this context ‘incidents’ relates to anything that does not come under crime so, for example, reports of missing persons or dealing with people with mental health.

For these reasons it is important to share information with local partners to maintain an understanding of the risks to Atherstone which may not get highlighted by crime and ASB data alone. An example of this local understanding is that during consultation, CSP representatives advised that there are thought to be a number of individuals in Atherstone who are involved in drugs misuse and potentially drug dealing.

Given that the recorded crime levels for the three wards are relatively low, a single high risk offender in the community can easily create a spike in offences. The Integrated Offender Management (IOM) team are able to track the most persistent and problematic offenders, release dates are monitored and relevant partners advised if a prolific/high harm offender is due for release into the community. The offender breakdown highlighted that a small number of female offenders in the age 30-39 age group were responsible for a much larger number of offences.

Recorded assault offences are spread out across the wards with no obvious specific locations to target; many of the offences involve families or acquaintances and have taken place at residential properties. The victim data suggests that the majority of violent crime victims are within the 20-29 age group. The difficulty with this type of crime is that much of it is spontaneous and difficult to predict and prevent. The offences which took place at the care homes in Atherstone Central ward are also very difficult to manage due to the nature of the individuals involved and would require a cross-agency approach to understand if more can be done to reduce these incidents.

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ROAD SAFETY & TRANSPORT

This section includes information on road safety and transport in and around Atherstone.

ROAD CASUALTIES

Warwickshire County Council’s Road Safety Intelligence Team manages data in relation to road traffic collisions. In 2015 there was an increase in the number of road casualties in North Warwickshire Borough from 266 in 2014 to 315 in 2015, an 18% increase.

In the three Atherstone wards of Central, North and South & Mancetter there has been an increase in road casualties over the past four years. In 2015 there were 24 road casualties recorded in the three Atherstone wards, where 79% of casualties received ‘slight’ injuries and 21% received ‘serious’ injuries. This has increased when compared to 2014 when there were 18 road casualties recorded, where one was a fatality, 72% received ‘slight’ injuries and 22% received ‘serious’ injuries. Figure 93 shows the trend of road casualties in the three Atherstone wards and the split by casualty type; fatal, serious and slight.

Figure 93: All Road User Casualties, Atherstone Central, North and Atherstone South & Mancetter, by Category (2012 – 2016)

30 Fatal Serious Slight 25

20

15

10 No. of RoadCasualties 5

0 2012 2013 2014 2015 2016* Source: Road Safety Intelligence Team, Warwickshire County Council. Note: The data for 2016 is incomplete as the Road Safety Partnership team are still waiting on returns. The majority of the accidents occurred in daylight hours (81%) with only 7% of accidents occurring when it was dark and no street lighting was present. Wet and damp weather can be a contributory factor to road traffic collisions in Atherstone where almost one third of road casualties (29%) had an accident which occurred on a ‘wet/damp’ day but the majority of accidents occurred in fine dry weather. Only 2% occurred in snowy conditions. Cars and taxis are the main vehicles involved in accidents and heavy goods vehicles were involved in 12% of the accidents recorded in Atherstone.

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Alcohol was only a factor in a small number of accidents (3%). Three of the road casualties were involved in an accident over the five year period which saw positive breath tests reported for drivers that were over the alcohol limit.

The number of pedestrians involved in accidents that occurred in Atherstone was very low. Over the five period 6% of the accidents had pedestrians involved and 4% of accidents had children involved.

The most popular day of the week for accidents to occur in Atherstone is on a Monday. The data reveals that Mondays saw the highest level of road casualties recorded, with 23% of accidents occurring on these days. This can be compared to Sunday when only 9% of accidents occurred.

Interestingly the most problematic time for accidents is during the day, not during morning peak times which would normally be expected due to the likely damper weather conditions and volume of traffic travelling to work and school. On a Monday the highest proportion of accidents occur between 13:00 – 18:00 across the three Atherstone wards (59%). More generally across the week, you are more likely to become a road casualty victim in Atherstone between the times of 13:00 and 18:00. A Department for Transport report has revealed that 72% of all accidents in the UK in 2014 were the result of driver reaction or error. The report also reveals that 25% were due to behaviour or inexperience and 23% due to injudicious action (for example this includes where a driver was travelling to close to a vehicle, disobeyed a traffic signal or exceeded the speeding limit). The reasons why the highest number of road casualties are reported between these times needs further exploration and one area to investigate may be shift working change over patterns which could be a contributory factor. It is recommended that the Road Safety Intelligence team in partnership with the North Warwickshire Community Safety Partnership further investigate the reasons behind the casualty figures occurring on these days and times.

Figure 94 focuses on the road type where the accident happened and also shows a breakdown by severity. Across the three Atherstone wards only one road casualty accident was recorded on a motorway. The roads in Atherstone which record the highest level of road casualties are A roads, typically around the A5. Over one third (39%) of road casualties recorded their accident as being on this type of road. ‘Other’ roads also remain a problem as 18% of road casualties recorded their accident as being on this type of road (these would be general roads off the main routes) and 17.5% of accidents with road casualties were recorded on a B road. The Road Safety Intelligence team have confirmed that there are currently no Casualty Reduction Schemes in the Atherstone area. Figure 94: Road Type and Severity of Accident

Fatal Serious Slight Total Motorway 0 0 1 1 A Road 1 10 27 38 B Road 1 4 12 17 Other Road 0 2 16 18

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Unclassified 0 3 20 23 Source: Road Safety Intelligence Team, Warwickshire County Council

ACCESS TO A CAR OR VAN

Atherstone Central ward has the highest percentage of households that do not have access to a car or van. The ward is well served by a number of bus services that pass by, or close to, the leisure, business and retail outlets in the town. Reasons for not having access to a car or van may be varied and could include the fact that the highest percentage of people claiming benefits linked to unemployment live in the ward therefore they may be unable to afford their own vehicle. A further link may be made with accommodation type in Atherstone Central; it has the highest percentage of flats/maisonettes/apartments that are rented (48.3%); again this may be due to low personal income.

CONGESTION

Figure 95 has been provided by the Transport & Highways team at Warwickshire County Council and shows congestion in the Atherstone area. The main area of congestion, which is shown on the map is in Atherstone Central ward in the town area, where between the peak morning times of 08:00 to 09:00 speeds are approximately 0 – 5 miles per hour.

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Figure 95: Traffic Congestion in Atherstone

ACCESS AND PUBLIC TRANSPORT

The A5 is a long distance strategic route which runs from London to Holyhead and, although use of it reduced with the opening of the M1 and M6, it still plays an important role in providing access to economic centres. A section of the route runs to the north west of Atherstone town centre; to the north and east there is a mixture of housing, industry and leisure facilities. In more recent years local authorities in the East and West Midlands have expressed growing concerns about capacity of the A5 which led to the establishment of the A5 Partnership. They are working with other agencies, including Highways England, to deliver a strategy for improvements to the route.

Atherstone is served by a number of bus services, the routes of which can be seen in Figure 96. Destinations include Nuneaton, Coventry, Tamworth and Leicester. Access to a frequent service means it is less vital for residents to have access to their own vehicle. The town also has a railway station with London Midland services running between London Euston and Crewe.

Figure 96: Bus routes in Atherstone town centre

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© Crown Copyright and database right 2017. Ordnance Survey 100019520.

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ENVIRONMENT & TECHNOLOGY

FUEL POVERTY

Fuel poverty data is produced by the Department of Energy and Climate Change at LSOA level. A household is considered to be fuel poor if they have required fuel costs that are above national average and, if they were to spend that amount, they would be left with a residual income below the official poverty line.

The latest 2014 data shows that, on average, 10.2% of households in North Warwickshire Borough are fuel poor with the figure for the worst LSOA being 16.5 %. The worst LSOA in Atherstone is Atherstone Central Centre; 12.4% of households are in fuel poverty. Figure 97 shows the rankings of the LSOAs for Atherstone.

Figure 97: Fuel Poverty in Atherstone

Generally those households that have a lower income are more likely to be fuel poor with the impact potentially being wide ranging. A cold home can have an adverse effect on health, particularly respiratory and circulatory problems and an increased risk of poor mental health. It has been estimated that 10% of excess winter deaths are directly attributable to fuel poverty (Public Health England, 2014). In addition a cold home can adversely affect children’s educational performance and absence from work.

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FLOODING

The Environment Agency has identified that some areas of Atherstone fall within Flood Zones 2 and 3; these are defined as follows:

• Flood Zone 2: land that has between 0.1% and 1% chance of flooding in any year • Flood Zone 3: land that has a greater than 1% chance of flooding in any year

As can be seen from Figure 98, these areas lie either side of natural watercourses that run through or near to the town, for example the River Anker and Innage Brook.

Whilst relatively few properties fall within either Flood Zone the impact of being flooded can be traumatic for any household that is affected. The effects can be economic (loss of property and possessions, potential impact on employment) and health related (mental and physical) as well as educational if a school or college is affected or if a family has to move to another area.

It should also be noted however that some of the proposed development in Atherstone, as outlined in the Draft Local Plan, falls within the flood zones. This has been acknowledged by North Warwickshire Borough Council with recommendations for flood mitigation included in the Plan.

WASTE

The lowest geographic level for waste data is district and borough and therefore this has not been included in this report. Data is available however at parish level for fly tipping incidents in the borough; between January and July 2016 a total of 354 incidents were reported of which six were in Atherstone North, 9 were in Atherstone Central and 14 were in Atherstone South & Mancetter wards. A hotspot was identified in one road in Atherstone Central with the other incidents being dispersed across the town. The locations are shown in Figure 99.

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Figure 98: Flood zones in Atherstone

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Figure 99: Fly tipping incidents

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AIR QUALITY

Currently there are no air quality management areas in North Warwickshire Borough, i.e. air quality in the borough is meeting the European Air Quality Objectives. The situation is monitored through the use of diffusion tubes located at a number of sites across the borough, two of which are in Atherstone. Both are in Atherstone Central Ward; one is at Long Street and one at South Street and both tubes measure levels of nitrogen dioxide.

GREEN SPACES

The North Warwickshire Green Space Strategy 2008–2018 states that, whilst there are a sufficient number of green spaces in the borough, their quality needs to be improved.

The Strategy defines a green space as areas used by the public including parks, landscaped spaces, sports pitches, children’s play areas, wildlife and countryside areas, allotments, cemeteries and churchyards. It goes on to outline why these spaces are important and quotes the Commission for Architecture and the Built Environment Green Space Strategies – a Good Practice Guide which says that “Green space is a vital part of the public realm. Attractive, safe and accessible parks and green spaces contribute positive social, economic and environmental benefits, improving public health, wellbeing and quality of life.”

Specific proposals for Atherstone that are listed in the Green Space Strategy include:

• The development of a formal “destination” park within the area. • The development of a sports “hub” at Royal Meadow Drive Recreation Ground to provide a range of good quality pitch sports provision with appropriate ancillary facilities. • Investment in the improvement of play facilities across the area, including the development of a major family facility. • Improving access to and within the Borough Council’s open spaces across the area and supporting similar improvements to other providers’ open spaces. • Working with local schools and other providers to meet the demand for more community access to good quality sports pitches. • Supporting the provision of a synthetic turf pitch in the area as the preferred location for this type of facility in North Warwickshire Borough. • Where appropriate, and in consultation with the local community, allow some informal open space to be developed for alternative green space uses, such as new play space, or for management as natural green space.

There are two allotment sites in Atherstone, both managed by Atherstone Town Council; one is off Gyspy Lane and the other can be accessed from Merevale View. It appears that they are popular facilities as there are waiting lists at both.

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TECHNOLOGY

In the UK, internet use is increasing across all adult age groups with only 10.2% now saying they have never used it, compared to 11.4% in 2015 (Internet users in the UK: 2016). The figures for Warwickshire in 2016 reflect the same pattern with 9% of people aged over 16 saying they had either never used the internet or used it over three months ago compared to 19.8% in 2011.

However, when this is broken down by age, approximately 40% of people aged 65 and over have not used the internet in the last 3 months in the UK, compared to only 4% of people between 16 and 64. Helping older residents to get online in the ways that they want will help them access information, advice and services more easily and cheaply, as well as connecting with people and activities that matter to them. As key services such as banking, pensions and utilities move increasingly online, people who do not use the internet will face a growing disadvantage. The Centre for Ageing Better launched a project in April 2017 to support more people to get the most out of digital technology and help gain a further understanding of barriers to internet usage and to identify offline approaches to help older people to benefit from the internet.

With increasing emphasis on online services comes a need for faster broadband connection; this is especially beneficial for people wishing to access online entertainment but can also be vital for more rural businesses. The Government has set a target for 95% of homes and businesses in each upper tier local authority area to be able to access superfast broadband by 2017. Superfast broadband is defined as offering speeds faster than 24Mbps (rising to 30Mbps for contracts signed from 2017 onwards)i.

The rollout is being undertaken in phases (contracts); the latest map showing coverage in Atherstone (Figure 100) shows that most of the town either already has superfast broadband or will have it by 2019.

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Figure 100: Superfast broadband coverage

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SERVICES

Figure 101 provides an overview of what services are available in the Atherstone and Mancetter area. The area has a wide range of services available for all community members.

Figure 101: Services in Mancetter and Atherstone

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INTERDISCIPLINARY HUBS

The Warwickshire North region provides medical care to approximately 188,000 people by 28 GP practices which vary in size and services. The area has a mix of rural and urban communities with a diverse demographic and social profile as well as health needs and health inequalities (as already highlighted in the report). The growing population has seen an increase in older, frail and vulnerable populations which has put pressure on services and housing. With planned developments of 25,400 additional properties across Warwickshire North, the pressure to support the residents with complex needs and long term conditions will only increase.

In 2015 the member practices of Warwickshire North CCG agreed to align into four geographic areas around which interdisciplinary hubs could develop. These are supported by South Warwickshire Foundation Trust’s locality based community teams, blending general community support with specialist nursing emergency response and intermediate care.

The aim is to build on this by developing the hubs so that they are also supported by social care and the third sector, tapping into the large range of community workers and social prescribing offers that already exist in these areas. This is about sharing information and aligning operating practices to make it easier for all these professionals to work together. The best way to achieve this vision is by joining up services through the development of interdisciplinary hubs where health, social care and third sector staff work together, with the individual and their families. Figure 102 illustrates the model of wrap-around care the interdisciplinary hubs are aiming to deliver.

Figure 102:

The Interdisciplinary Hub shared vision

The table below aligns the vision to the respective objective and outcome the hubs aim to achieve.

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To support the frail and vulnerable to maximise their independence and empower them to make choices that fit with their lives and deliver better outcomes for health and well being

Shared Vision Objective Outcomes

A Easy access to Sustainable care where individuals A reduction in the number of people high quality are confident that they can access admitted as an emergency as a result responsive the help they need when they need of services working together to services it. coordinate care including timely responses to escalating needs. Clarity about the range of health, social and third sector services All the health and wellbeing needs of available and how to access them the individual are considered

Services and information will also People feel supported to manage their focus on preventing ill-health own health and well -being and are confident to do so.

B Rapid response Frail and vulnerable individuals will Unnecessary emergency admissions to to urgent needs be actively case managed and hospital are avoided. supported by the right professionals to manage and respond to Individuals are supported to remain at escalating and urgent care needs home where appropriate including end of life care.

C Providers Collaborative working between A broader team around each of the working health, social care and third sector interdisciplinary hubs focussed on together providers to co-ordinate and deliver delivering care around the needs of the seamless care individual

Ownership from each contributing organisation to working in partnership with the other hub members

Hub teams to establish themselves with a mandate to identify gaps in service and put plans in place to address these by making use of all statutory and third sector services available in the area.

Improved communications between providers so that individuals do not have to repeat their stories.

D Simplified The development of clear care Individuals participate in the planned care pathways across acute, community, development of their care plans. pathways primary and social care. Care plans shared with all relevant

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providers

Clarity about how to access care pathways and about the role of each provider.

Continuity of care for residents regardless of care setting or care pathway.

E Appropriate People stay in hospital until they are A reduction in the number of delayed time in hospital medically fit for discharge and then transfers of care as patients spend only move to an appropriate setting for appropriate time in hospital and are further rehabilitation or well supported to leave hospital when assessment. their acute episode is complete.

WARWICKSHIRE NORTH LOCAL ESTATES FORUM

The Warwickshire North Local Estates Forum (LEF) meets on a monthly basis to discuss local estate opportunities and service relocation/co-location opportunities across the CCG area. The LEF members include estates leads from primary care (Warwickshire North CCG), secondary care (George Eliot Hospital), mental health (Coventry and Warwickshire Partnership NHS Trust) and community care (South Warwickshire NHS Foundation Trust).

As well as this, to help ensure that decisions are informed by local growth plans, planners (and estates leads) from both of the borough councils also attend. The LEF has responded to local growth plans and are working on a framework which will inform Infrastructure Delivery Plans (IDPs), detailing health infrastructure requirements across the whole health system.

ATHERSTONE MASTERPLAN

During August 2015, Atkins (an engineering consultancy) was invited to submit a proposal for developing a masterplan vision and action plan for Atherstone town centre. The vision looks to develop the town centre as a vibrant centre for the local community, whilst improving its economic position in the long term. This primarily focused on the physical space and how the town works as a whole, including what could be done to improve it, making it work better for residents and tourists alike, developing potential options to take forward.

Colleagues across North Warwickshire Borough are working with a group of town centre/tourism businesses to look at delivering projects, initially from a previous Atherstone Visitor Audit and to take forward potential options and projects set out in the masterplan. Of particular interest, is the area around the leisure centre, library, memorial hall and clinic where it has been identified that a number of public services could work better together and use space more efficiently.

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WARWICKSHIRE COMMUNITY AND VOLUNTARY ACTION

The following intelligence from Warwickshire Community & Voluntary Action (WCAVA) provides a narrative and intelligence, covering a two year period (Feb 2015 – Feb 2017) in relation to the number of: • Community groups/grass roots activities • Groups supported with funding • Groups supported with governance • Volunteers in Atherstone and Mancetter • Volunteer hours each week/month/year

WCAVA is the countywide infrastructure organisation for Warwickshire providing: • Support and advice to community groups, voluntary sector organisations, charities and social enterprises • Brokerage of volunteer opportunities and matching volunteers to placements, promoting the highest quality experience • Support and sharing of good practice on volunteer management with volunteers involving organisations • Opportunities to learn by providing high quality training that meet the needs of the voluntary and community sector • To engage with strategic partners on behalf of the voluntary and community sector, to build better relationships • To inform residents of opportunities and influence change.

WCAVA offices are located in Stratford-upon-Avon, Warwick District, Rugby Borough, Nuneaton & Bedworth Borough and North Warwickshire Borough.

Numbers of registered charities providing services in Atherstone WCAVA has identified 19 registered charities within Atherstone. Two are churches (excepted charities) that provide benefit to the wider community and one is a charitable trust.

Registered Charities include: - St. Marys Church - Beeline Community Car Service

- Volunteer Centre North Warwickshire - Trinity Church

- NW Citizens Advice Bureau - Rotary Club of Atherstone Trust Fund

- Leading Players CIO - Happy Faces Pre-school - Queen Elizabeth Academy Charity - Atherstone Amateur Dramatic Society

- Atherstone Theatre Workshop - North Warwickshire Arts Council

- Friends of Atherstone Heritage - The Atherstone Ladies Club - Atherstone Choral (CIO) - The Atherstone Choral

- The NW Association of Women’s Clubs - 1st Atherstone Scout Group

- Owen Street Community Arts Centre - Individual Support Solutions Atherstone - Cohort 4

Individual Support Solutions provides a community wellbeing hub for adults with learning disabilities and their carers. Cohort4 provides activities and project work for women affected by domestic abuse. Both are registered with Companies House. 120

Number of volunteers in registered charities We are only able to make a definitive calculation of the number of volunteers who are registered as Trustees in 17 of the registered charities above. The total number of trustees equates to 92.

WCAVA know that Trinity Church and St. Marys Church have 6 volunteers between them as they have met with them previously regarding funding options and support with funding applications. WCAVA do not have numbers of additional volunteers that will volunteer for the above charities – also these numbers will vary as time commitment and interests of volunteers’ changes.

WCAVA do not record the number of hours a volunteer commits to a charity although they know that Trustees of a registered charity will be under an obligation to take time to prepare and attend regular Board meetings and this will vary according to a charities constitution.

Number of community groups WCAVA have identified the following community groups in Atherstone:

- North Warwickshire Over 50s - Girls Friendly

- North Warwickshire Older Peoples Forum - Atherstone Hub (St. Marys ) WCAVA do not collate numbers of volunteers, however they know that 11 of these groups are - St. Marys Mother and Toddler Group - Restore Trust constituted, therefore they will have a minimum of three volunteer committee members. - Atherstone and District Blind - Atherstone Library

- Sparkles Project Atherstone - Dickens Night Charities /community groups supported with funding - The Gateway Club - Arts and Crafts Group (VC) WCAVA have supported many of these groups/charities with their funding needs, however, over the - Welcome Club - Atherstone Art Group past two years they have supported nine of these charities/community groups to gain funding. - Mothers Union - UK Online (VC) Funding gained totals £331,174.92. - Meet and Eat (VC) - Stonefest

- Atherstone Civic Society

WCAVA have some constituted groups that do not wish to apply for funding. This is mainly the groups that have members that pay a weekly fee to attend meetings. This payment will be enough to pay for the room rental and other activities. Some of these membership groups have also told WCAVA that they do not wish to apply for funding as they prefer to keep their income below the amount of which they would need to register with the charities commission.

WCAVA have also worked with the Rotary Club of Atherstone Trust Fund. Before working with the Trust, they only gave grants to registered charities however, after discussion the Trustees, along with their head office, they now give to constituted groups.

Charities and community groups supported with governance WCAVA have done extensive work with Friends of St. Marys, Restore Trust and the Leading Players on becoming a Charitable Incorporated Organisation (CIO). Restore Trust is going through the process and the Leading Players is now registered.

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WCAVA have been through the governance process with five community groups whilst taking them through the constitutional process. This process will take new groups through; carrying out their charitable aims, membership, trustee meetings, general meetings, AGMs and money and property.

Numbers of identified charities within Mancetter

• Mancetter Memorial Hall • St. Peters Church Mancetter • Mancetter First Scouts

Two of the above charities are registered with the Charity Commission. The Church is an excepted Charity and therefore does not need to register. We can identify 18 Trustees between these two charities however; we do not know how many additional volunteers they have.

Coventry and Warwickshire MIND and Barnardos are both Charities that provide services for Mancetter.

Number of community groups in Mancetter WCAVA have identified the following community groups in Mancetter:

- Mancetter Hub (information point) - Mancetter Community Group - Bongo & Bowls - W.I. - Friends of Mancetter Tea & Chat - Prize Bingo - Brownies & Guides

Bingo and Bowls has its own constitution, however, Mancetter Community Group and Tea and Chat are administered through Mancetter Memorial Hall.

WCAVA has supported Laurel Gardens community café with funding options for their business.

Volunteering

Organisations in Atherstone and Mancetter that are registered on Volunteer Connect are:

There are 10 people from Atherstone & Mancetter registered as volunteers on Volunteer Connect. - St. Marys Church (supported to do this) - Friends of St. Marys

- Atherstone Town Cricket Club - Age UK The Volunteering Coordinator at WCAVA has worked with a further 4 volunteers that are not - Keyring - Volunteer Centre NW registered on Volunteer Connect. The Volunteering Coordinator is also working with the Job Centre - Mancetter Community Hub - North Warwickshire Borough CAB and they will be referring clients to WCAVA that are looking for volunteering placements. They have - Friends of Atherstone Heritage - Atherstone Civic Society - Atherstone Library

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so far referred one person that lives in Atherstone. The Volunteering Coordinator has held a drop in session at Atherstone Hub & Atherstone Library and will have a market stall to support promotions.

VOLUNTEER CENTRE

A resume of the projects run by the Volunteer Centre, based in Atherstone is included below. All have the propensity to improve health and wellbeing in a variety of ways and anecdotally have a great impact on people’s lives, either by being a volunteer or attending groups run by volunteers.

• Allotment project – managed by volunteers 3 days a week and the produce grown is used in our Tea Rooms (3 volunteers). • Woodwork project – held weekly by volunteers, making bird boxes, tables etc. for sale to local people (6 volunteers). • Craft Group – runs weekly, managed by a volunteer, making arts and crafts to sell in the Centre and beyond (15 volunteers). • Computer / Job Club – runs weekly, managed by a volunteer, assisting people with CV’s, job searching and training people on the Learn my Way computer training course (2 volunteers, supporting in the region of 45 people). • Memory Café – runs weekly, for people diagnosed with dementia and their carers. This offers support for both groups through Alzheimer’s Society and a social event to mix with others in a similar situation (10 volunteers, supporting 8 families). • Lunch Club – runs weekly, offering a meal and hot drink for £4 from 12pm-2pm, open to anyone (10 volunteers). • Meet and Eat Sessions – held on the 3rd Thursday of each month. This service is for people who have dementia, to be collected from home, taken to the Centre for a hot meal and a drink and some form of entertainment and then taken home, at a cost of £8. This runs between the hours of 11am-2pm approximately (10 volunteers, supporting 10 families).

Alongside the above, the Volunteer Centre offers volunteer recruitment throughout North Warwickshire Borough, matching volunteers to organisations which best suit their ability and skills. Their progress is monitored throughout their volunteering time and their training or progression they may need for future life skills is also managed.

COUNCILLOR GRANTS & FUNDED PROJECTS

Grant funding is awarded to Councillors in North Warwickshire Borough each year to support specific projects. Figure 103 presents a summary of projects funded for the areas of Atherstone and Hartshill (due to electoral boundaries) over recent financial years and gives an idea of community projects supported in the area over time.

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Figure 103: Funded projects Electoral Division Group Project Amount Area Agreed ATHERSTONE: Volunteer Centre North Running Costs for Allotment £1,000.00 Warwickshire Borough Escape Arts Atherstone & Hartshill Dementia £500.00 Café Carers Support Services Residential for Young Carers £150.00 (Warwickshire Young Carers Project) Dickens Night Road Closures for Christmas Light £500.00 * 2016/17 Switch On Atherstone Adders Hockey Club Purchase of Goal Keeping Kit £500.00 Phantom Knights Purchase of 2 Mellophones £275.00 Atherstone Art Group Painting Exhibition £500.00 St Mary's Stay & Play Purchase of Equipment £300.00 Friends of the Square Purchase of Trestle Tables £500.00 Stonefest Summer Event £500.00 TOTAL: £4,725.00 NW Older People's Forum Speakers/Entertainment, transport £500.00 costs, Venue Hire & Refreshments Pennies Worth Carboot & fair Car boot & craft fair Phantom Knights Musical instruments £440.00 North Warks First Responders Equipment required to support the £231.00 free defibrillator to be sited in Atherstone Market Square Atherstone Town Cricket Club Purchase boundary rope and rope £550.00 2015/16 winder Friends of Atherstone Heritage Display boards, Laptop, Storage £665.00 boxes Owen Street Community Arts Demolition of outbuilding £1,825.00 Centre St Mary's Parish Church Stay & Play Sessions £300.00 Atherstone Targeted Support for Young Set Up a Community Café £500.00 People TOTAL: £5,011.00 Atherstone Adders Hockey Club Coaching and other courses £400.00 Phantom Knights Baritone Trumpet £600.00 Crossroads Trust Hao Shen Project room hire/ £750.00 expenses 2014/15 Cohort 4 Ltd All About Men £750.00 Volunteer Centre North Support Food Bank form Volunteer £1,060.00 Warwickshire Borough Centre Allotment Warwickshire Vision Support Transportation £1,440.00 TOTAL: £5,000.00 2013/14 Atherstone Adders Hockey Club Junior Training Sessions £480.00

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Volunteer Centre North Training for 20 volunteers to run the £500.00 Warwickshire Borough tea room Bromford Support Learning Be Creative: The Arts' music, arts & £216.35 Disability Hub craft sessions Atherstone District Scout Council Recruitment campaign, equipment & £500.00 training Leading Players Drama Group To purchase a small portable PA £343.65 system & bubble machine Trinity Church Replace faulty disabled toilet and £400.00 worn flooring in ladies & gents Crossroads Trust Helping ex-offenders re-entry into £1,560.00 society Values Education for Life Support to vulnerable young people £500.00 Atherstone G.F.S. Contribution to newer minibus £500.00 TOTAL: £5,000.00 HARTSHILL Escape Arts Atherstone & Hartshill Dementia £500.00 Café Carers Support Services Residential for Young Carers £150.00 (Warwickshire Young Carers Project) Hartshill Over 50s Club 10 Year Celebration Party £300.00 Dickens Night Road Closures for Christmas Light £500.00 Switch On * 2016/17 Ridge Lane Youth Club Continuation of Youth Club £135.00 2nd Hartshill Brownies & 2nd Purchase of Equipment £518.00 Hartshill Guides Phantom Knights Purchase of 2 Mellophones £275.00 Mancetter Community Group Purchase of Mat for Indoor Bowling £500.00 Friends of the Square Purchase of Trestle Tables £500.00 Stonefest Summer Event £500.00 TOTAL: £3,878.00 The Links Daycare Centre Ltd 2 Help Project - equipment £1,800.00 Hartshill Sports Hotshots Junior Costs and equipment to set up an £800.00 Football Club under 9's team Atherstone Summer in the Band for event 22/08/2015 £900.00 Square Mancetter Memorial Hall/Hub Community Fun day and launch of £240.00 the Hub 2015/16 Mancetter Tenant Led Bingo Machine & accessories & £277.23 Community Group bowling equipment Hartshill Community Café Equipment for café £185.00 North Warks First Responders Equipment required to support the £231.00 free defibrillator to be sited in Atherstone Market Square Dare2Dream Foundation Time2Shine Personal Development £3,750.00 Programme

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Targeted Support for Young Set Up a Community Café £500.00 People TOTAL: £8,683.23 Phantom Knights Trombone £595.00 Hartshill & District Residents Set Up a Website £600.00 Group Atherstone Rugby Club Refurbishment of portable £1,500.00 floodlights from Atherstone Rangers 2014/15 by replacing power packs and light fittings Ridge Lane Youth Club Wildlife Project £138.50 Ridge Lane Methodist Church & Redecoration of Community Hall £700.00 Community Hall TOTAL: £3,533.50 Hartshill Over 50s Club Day out to the coast for 48 members £150.00 1st Hartshill Scout Group To purchase sports & games £250.00 equipment, arts & crafts materials 2nd Hartshill (Holy Trinity) To help fund events for 100 years of £1,500.00 Brownies Brownies during 2014 2013/14 Hartshill Community Café Equipment for the café £250.00 Hartshill Community Centre Bingo Machine £150.00 Snow Hill Pavilion Boot Cleaner for the recreation £100.00 ground Hartshill Ladies Group Day out to celebrate 50th £100.00 Anniversary of the group TOTAL: £2,500.00 *Partial year

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