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NHS Sheffield Comprehensive Health and Well-Being Needs Assessment

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NHS Sheffield Comprehensive Health and Well-Being Needs Assessment NHS Sheffield Comprehensive Health and Well-Being Needs Assessment for Children and Young People with LDD (Learning Disabilities and/or Difficulties Report June 2009 CONTENTS 1. Introduction............................................................................................................ 1 2. Key Findings.......................................................................................................... 2 3. Definition of Population.......................................................................................... 6 4. External Research............................................................................................... 20 5. Map Current Services.......................................................................................... 24 6. Health & Well-being Needs of Population ........................................................... 29 7. Predict Future Needs........................................................................................... 36 8. Stakeholder Analysis........................................................................................... 58 Appendix 1: External Research Findings Appendix 2: Population Data Appendix 3: Sheffield Services for Children with LDD Appendix 4: Sheffield – Special Educational Needs Criteria Prepared for Kate Laurance Children’s Services Specification Manager NHS Sheffield 722 Prince of Wales Road Sheffield S9 4EU 0114 3051172 Prepared by Colin Brookman Contract Number TCC2325 Version 1.1 DOCUMENT HISTORY Version Date of Issue Comment 1.0 June 30th 2009 Final Report 1.1 August 20th 2009 Correction of formatting errors on diagrams & paragraph numbering 1. INTRODUCTION 1.1 This assessment has been commissioned by NHS Sheffield with the following objectives: • To identify numbers of children and young people with LDD within Sheffield and predict future trends, based upon diagnostic profile and DDA criteria. • To identify both current and predicted future needs in order to inform appropriate planning and delivery of services. • To identify health and well-being need across health, social care, and education and housing spectrums. • To identify health and well-being need across the different groups of children and young people defined as LDD as defined within specification and by age range. 1.2 The assessment covers all children and young people who fall within the commissioning responsibilities of NHS Sheffield from age 0-19+ who are identified as having a learning disability and/or difficulty. The definition of LDD used is that defined in The Disability Discrimination Act (1995) as someone who has “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities”. 1.3 The approach adopted to the assessment has been to: • Research and identify appropriate datasets to capture the population and its characteristics. • Use these datasets to project future needs for the period 2009-12. • Identify and map services currently available to support the population. • Research information on services available in other local areas to identify approaches which could usefully be adopted in Sheffield. • Review specific services available within Sheffield to support Health and Well-being Needs for children with LDD. 1.4 The major findings and recommendation from this work are summarised in Section 2. The detailed findings from the above activities are discussed in the main body of the Report and its Appendices. Page 1 2. KEY FINDINGS DATA SET 2.1 The Dataset used for this work was the DCSF 2008 census data for Sheffield schools. This covered the main school population (Age 5-16 approximately). The age 17-19 population was estimated using projections of the DCSF data from previous years. 2.2 A comprehensive, accessible dataset for the pre-school population was not available. However, the DCSF 2008 census does include data on children in nursery schools. This is not a complete dataset for the age range in that it excludes the very youngest children and not all pre-school children are in a nursery setting. Despite this the data was felt to provide some insight into the characteristics of this part of the population and was therefore included in the review. 2.3 It became apparent during the assessment that there is no single, comprehensive database covering all children and young people who fall within the DDA definition of disability. Facilities such as the Sheffield Case Register and the Sheffield Disability Index contain excellent data. Indeed, the Case Register is recognised as one of the best of its kind nationally. However, they each have limitations in terms of: • Coverage – they are voluntary facilities so not all disabled people will be recorded; in particular their coverage at the younger end of the age-scale is limited. • Scope – they tend to cover people with more complex disabilities. Hence, those with more moderate conditions are not covered. 2.4 It is recommended that Sheffield should consider the best approach to ensuring that it has a single, comprehensive and consistent dataset covering its population of children and young people with LDD. POPULATION 2.5 The population of children with LDD in the Sheffield school system (defined to be those with statements or in school action plus) for age 5-16 is 8,976 of which 88 come from out of Sheffield. The projected number for age 17-19 is 1,699. The pre-school population identified through the DCSF census of nursery schools is 176. 2.6 For the school population the Service Districts with the largest population are Arbourthorne /Manor /Darnall (17.2%) and Shiregreen / Burngreave (19.4%). These are also the districts with the highest indices of social deprivation. Page 2 2. KEY FINDINGS (CONTINUED) 2.7 The most common Primary Needs within the school population are: • Moderate Learning Difficulties (MLD) (28.5%). • Behavioural, Emotional and Social Development Difficulties (BESD) (21.8%). • Speech, Language and Communication Needs (SLCN) (16.2%). • Special Learning Difficulties (SPLD) (e.g. Dyslexia) (13.7%). 2.8 21.5% of the school population with LDD come from the BME community 2.9 Children with LDD are more likely to be eligible for free school meals; 29.2% of children with LDD in the age range 5-16 take free school meals compared with 16.6% of the Sheffield school population as a whole. The difference is particularly marked for children with BESD (35.4%), Severe Learning Difficulties (SLD) (34.4%) and MLD (33.7%). 2.10 The 17-19 population has broadly similar characteristics to the 5-16 years age group. 2.11 The analysis of the available data for pre-school children indicates a very high percentage of children with SLCN (45.5%). For this population Shiregreen /Burngreave, again, has the highest representation (22.4%). The percentage of this population from a BME background is significantly higher than for the main school population at 36.9%. POPULATION GROWTH 2.12 DCSF census data for school age children from 2005-8 was analysed to develop growth projections for the Sheffield population. These were compared to national growth rates over the same period. 2.13 The average annual growth rate for children with LDD needs in Sheffield over the period 2005-8 is 5.1%. This compares to a comparative national figure of 3.1%. 2.14 The rate of growth in Sheffield for all categories of Primary Need exceeds the national rate. The exceptions are BESD and Visual Impairment (VI). 2.15 The fastest growing areas of Primary Need in Sheffield are Autistic Spectrum Disorders (ASD) (16.8%), SLCN (13.5%) and SLD (9.5%). ASD (6.5%) and SLCN (10.5%) are also the fastest growing categories nationally. 2.16 For ASD and BESD the Sheffield growth rate for 2007-8 is radically different from those for 2005-7. This may reflect improvements in diagnosis capability during the early part of the period, the impact of which has now levelled out. These rates should therefore be revisited when 2009 data is available. Page 3 2. KEY FINDINGS (CONTINUED) 2.17 The Service Districts with the highest growth rates for children with LDD (7%) are Shiregreen / Burngreave and Greenhill / Gleadless Valley. Arbourthorne /Manor/ Darnall, which currently has one of the largest populations of LDD children has an average growth rate which is quite significantly lower than the rest of the City. 2.18 The growth rate within the BME community (8.9%) exceeds that of the White British community (4.2%). The difference is particularly pronounced in ASD and Profound & Multiple Learning Difficulties (PMLD). POPULATION PROJECTIONS 2.19 The children with LDD population was projected using rates of growth from 2005-8 for the White British and BME populations. 2.20 The projections indicate a growth in the total children with LDD population which averages at about 6.3% per annum over the period 2009-2012. On this basis the percentage of children from BME communities will increase from 21.5% to 25.5%. 2.21 The greatest increases will be experienced in the numbers of children with ASD, SLCN and PMLD. It is the services supporting children with these conditions which will experience the greatest increases in demand. SERVICE NEEDS 2.22 All services are experiencing demand which equates to, or exceeds, their nominal capacity. There is particular pressure on therapist resources (SLT, Physio, and OT) and on assessment clinics (Multi-disciplinary Assessments and Social & Communication Disorders Clinics). 2.23 The Dual Diagnosis service for children with LDD and mental health problems is
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