Worcestershire Health and Well-being Board

Redditch Needs and Assets Profile

March 2018

www.worcestershire.gov.uk/jsna

Redditch Needs and Assets Profile Table of Contents

1. Foreword ...... 7 2. Executive Summary ...... 9 3. Methods ...... 11 3.1. Assets of Redditch: data collection, analysis and interpretation ...... 11 3.2. Quantitative data collection, analysis and interpretation ...... 12

Part One: Assets in Redditch ...... 13

4. An Asset Based Approach in Redditch ...... 14 4.1. Mapping the assets ...... 14 4.2. What creates Wellbeing in Redditch? ...... 19 4.3. Building on the assets ...... 20 4.4. The assets in Redditch ...... 22

Part Two: Needs profile in Redditch ...... 29

5. Redditch Overview ...... 31 5.1. Geography and wards of Redditch ...... 31 5.2. Population ...... 32 5.2.1. Birth rates and fertility ...... 33 5.3. Age ...... 35 5.4. Ethnicity ...... 38 6. Redditch Health at a glance ...... 40 7. Wider determinants of health ...... 42 7.1. Deprivation ...... 42 7.2. Education ...... 45 7.3. Early Years Foundation Stage (EYFS) ...... 45 7.4. Key Stage One (KS1) ...... 47 7.5. Key Stage Two (KS2) ...... 53 7.6. GCSE ...... 55 7.7. A-Level ...... 57 7.8. Free School Meals ...... 58 7.9. Crime ...... 59 8. Smoking ...... 62 8.1. Smoking and pregnancy ...... 64 8.2. Smoking related morbidity and mortality ...... 70 9. Alcohol ...... 73 10. Physical Activity ...... 80 11. Mental Health ...... 89 11.1. Prevalence and Incidence ...... 89 11.2. Self-Harm indicators ...... 91 11.3. Access to Mental Health services ...... 94 12. Other Areas of Concern and Changing Needs ...... 98

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12.1. Hospital admissions caused by unintentional and deliberate injuries in children ...... 98 12.2. Recorded Diabetes ...... 100 12.3. Influenza Vaccination ...... 101 12.4. Chlamydia Detection Rate 15-24yr olds ...... 101 13. References ...... 102 14. Appendix ...... 104 14.1. Appendix One ...... 104

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Redditch Needs and Assets Profile Table of figures and tables

Table of figures and tables ...... 4 Be active map ...... 15 Take notice / Give map ...... 16 Connect map ...... 17 Keep learning map ...... 18 Figure 1: Wards and ward boundaries of Redditch district ...... 31 Figure 2: Population history in Redditch since 1980 ...... 32 Figure 3: Population projections in Redditch until 2039 ...... 32 Figure 4: General Fertility Rate (GFR) – all live births per 1,000 women aged 15-44 by area in 2016 33 Figure 5: Under 18s birth rates per 1,000 by area in 2015 (note, this is a crude rate) ...... 33 Figure 6: Under 18s birth rates per 1,000 trend from 2009 - 2015 in Redditch and England ...... 34 Figure 7: Birth rate in 2014 per 1,000 women aged 15-44 by IMD decile (2015 – 1 being the most deprived area and 10 being the least deprived) ...... 34 Figure 8: Percentage of population by age groups in 2016, mid-year population estimates ...... 35 Figure 9a: Population pyramid for Redditch, 2016 ...... 37 Figure 9b: Population pyramid for Worcestershire, 2016 ...... 37 Figure 10: Percentage of population by broad ethnic group in 2011 ...... 38 Figure 11: Proportion of black and minority ethnic population by ward in Redditch ...... 39 Figure 12: Redditch Health summary spine chart for key health indicators ...... 41 Figure 13: Deprivation in Worcestershire ...... 42 Figure 14: Deprivation in Redditch ...... 43 Figure 15: Percentage of population in Redditch living in areas at each level of deprivation compared to England ...... 44 Figure 16: Percentage of pupils achieving a good level of development at the Early Years Foundation Stage; 2014 – 2017 by ward compared with National average ...... 45 Figure 16a: Percentage of pupils achieving a good level of development at the Early Years Foundation Stage; 2014 – 2017 by district and region compared with National average ...... 46 Figure 17: Percentage of pupils achieving expected standard of reading at KS1; 2016-2017 by ward compared with National average ...... 47 Figure 17a: Percentage of pupils achieving expected standard of reading at KS1; 2016-2017 by district compared with National average and the West Midlands ...... 48 Figure 18: Percentage of pupils achieving expected standard of writing at KS1; 2016-2017 by ward compared with National average ...... 49 Figure 18a: Percentage of pupils achieving expected standard of writing at KS1; 2016-2017 by district compared with National average and the West Midlands ...... 50 Figure 19: Percentage of pupils achieving expected standard of maths at KS1; 2016-2017 by ward compared with National average ...... 51 Figure 19a: Percentage of pupils achieving expected standard of maths at KS1; 2016-2017 by district compared with National average and the West Midlands ...... 52 Figure 20: Percentage of pupils achieving expected standard of Reading, Writing and Maths at KS2; 2016- 2017 by ward compared with National average ...... 53 Figure 20a: Percentage of pupils achieving expected standard of Reading, Writing and Maths at KS2; 2016-2017 by Worcestershire district compared with National average ...... 54 Figure 21: Percentage of pupils Gaining A*-C/9-4 English and Maths at GCSE by district and region 55 Figure 22: Percentage of pupils Gaining A*-C/9-4 English and Maths at GCSE by ward compared to England average ...... 56 Figure 23: Average Points per entry for A-Level pupils by ward compared to England average...... 57 Figure 23a: Percentage of pupils known to be eligible for free school meals by district in Worcestershire compared to regional and national average - 2017 ...... 58 Figure 24: Crime deprivation in Redditch ...... 59

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Redditch Needs and Assets Profile

Figure 25: Violent crime (including sexual violence) - hospital admissions for violence; Directly standardised rate - per 100,000 ...... 60 Figure 26: Violent crime (including sexual violence) - violence offences per 1,000 population; Crude rate - per 100 ...... 60 Figure 27: Violent crime (including sexual violence) - rate of sexual offences per 1,000 population, Crude rate - per 1,000 ...... 61 Table 1: Smoking prevalence in adults – current smokers in Worcestershire by district and comparison with the English average (15.5%) ...... 62 Table 2: Smoking prevalence in adults in routine and manual occupations – current smokers in Worcestershire by district and comparison with the English average (26.5%) ...... 63 Figure 28: Proportion of pregnant women smoking at time of delivery, by year and district (2013 – 2016), compared to England and the West Midlands ...... 64 Figure 29: Smoking at time of delivery, trend in Redditch and England from 2011 to 2016...... 65 Figure 30: Proportions of Low birth weight of term babies by ward in Redditch (%) ...... 66 Figure 31: Proportion of all mothers who breastfeed their babies in the first 48hrs after delivery ...... 67 Figure 32: Breastfeeding prevalence at 6-8 weeks after birth – 2014/15 ...... 67 Figure 33: Premature live births (gestational age less than 37 weeks) and still births per 1,000 live births and stillbirths by area in 2015/16 ...... 68 Figure 34: Premature live births (gestational age less than 37 weeks) and still births per 1,000 live births and stillbirths in Redditch and England from 2006 - 2015 ...... 69 Figure 35: Infant mortality - Rate of deaths in infants aged under 1 year per 1,000 live births (2014-2016) ...... 69 Figure 36: Age-standardised rate of mortality from chronic obstructive pulmonary disease per 100,000 population by district, 2014-2016 ...... 70 Figure 37: Age-standardised rate of mortality from chronic obstructive pulmonary disease per 100,000 population in Redditch from 2001 to 2016 ...... 71 Figure 38: Emergency hospital admissions for chronic obstructive pulmonary disease, standardised admission ratio 2011/12- 2015/2016 ...... 71 Figure 39: Age-standardised rate of mortality from lung cancer per 100,000 population, 2014-2016 .. 72 Figure 40: Hospital admissions for alcohol-related conditions, all ages by district, England and West Midlands. Directly age standardised rate per 100,000 population, 2015/16 ...... 73 Figure 41: Hospital admissions for alcohol-related conditions, under 40s, directly age standardised rate per 100,000 population - 2015/16 ...... 74 Figure 42: Hospital admissions for alcohol-related conditions, over 65s, directly age standardised rate per 100,000 population - 2015/16 ...... 75 Figure 43: Hospital admissions for alcohol-related conditions, all ages for Redditch and England, 2008/09 – 2015/16. Directly age standardised rate per 100,000 population ...... 75 Figure 44: Hospital admissions for alcohol-related harm in Redditch for Females by year from 2008 to 2016, per 100,000 population ...... 76 Figure 45: Hospital admissions for alcohol-related conditions, under 18 for Redditch and England, 2006/07 – 2015/16. Directly age standardised rate per 100,000 population ...... 77 Figure 46: Hospital admissions for mental and behavioural disorders due to use of alcohol condition, all ages, directly age standardised rate per 100,000 population – 2015 / 16 ...... 78 Figure 47: Hospital admissions for alcohol-related cardiovascular disease conditions, all ages by district, directly age standardised rate per 100,000 population – 2015 / 16 ...... 79 Figure 48: Physical activity spine chart, key indicators and related conditions for Redditch ...... 80 Figure 49: Percentage of physically active adults (19+) by area in 2015/16 ...... 81 Figure 50: Percentage of physically inactive adults (19+) by area in 2015/16 ...... 82 Figure 51: Percentage of adults who do any walking, at least five times per week, by area in 2014/1582 Figure 52: Percentage of adults who do any walking, at least once per week, by area in 2015/16...... 83 Figure 53: Percentage of adults (aged 18+) classified as overweight or obese, by area – 2015 / 16 .. 84 Figure 54: Prevalence (%) of overweight (including obese) children in Reception and Year 6 by district in 2016/17 ...... 85

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Figure 55: Prevalence (%) of overweight (including obese) children in Reception between 2006/7 – 2015/16 in Redditch ...... 86 Figure 56: Prevalence (%) of overweight (including obese) children in Year 6 between 2006/7 – 2015/16 in Redditch ...... 87 Figure 56a: Reception Year – percentage overweight or obese by deprivation quintile in 2016/17 ..... 87 Figure 56b: Year 6 – percentage overweight or obese by deprivation quintile in 2016/17 ...... 88 Figure 57: Depression recorded prevalence (QOF): % of practice register aged 18+; NHS Redditch and Bromsgrove compared with England, 2015/16...... 89 Figure 58: Depression recorded prevalence (QOF): % of practice register aged 18+; comparison of CCGs in Worcestershire and England average, 2015/16 ...... 90 Figure 59: Depression recorded incidence (QOF): % of practice register aged 18+; NHS Redditch and Bromsgrove compared with England, 2015/16...... 91 Figure 60: Emergency Hospital Admissions for Intentional Self-Harm in Redditch in comparison to England (hospital admissions per 100,000) ...... 92 Figure 61: Emergency Hospital Admissions for Intentional Self-Harm, all ages by area and gender, directly age standardised rate per 100,000 population – 2015 / 16 ...... 93 Figure 62: Emergency Hospital Admissions for Intentional Self-Harm, all ages by year and gender in Redditch, directly age standardised rate per 100,000 population – 2015 / 16 ...... 93 Table 3: Hospital admissions as a result of self-harm: DSR per 100,000 population aged 10-24 by CCG in the West Midlands; 2014/15 ...... 94 Figure 63: Entering IAPT treatment: crude rate per 100,000 population aged 18+; NHS Redditch and Bromsgrove compared to England to 2016/17 ...... 95 Figure 64: Access to IAPT services: people entering IAPT (in month) as % of those estimated to have anxiety/depression to 2016/17; NHS Redditch and Bromsgrove CCG compared to England95 Figure 65: Completion of IAPT treatment: rate (quarterly) per 100,000 population aged 18+; NHS Redditch and Bromsgrove CCG compared to England 2013 - 2017 ...... 96 Table 4: Rate of bed days for children and young people aged under 18 in CAMHS (2015/16) ...... 97 Table 5: Rate of admissions for children and young people aged under 18 in CAMHS tier 4 wards (2015/16)...... 97 Figure 66: Hospital admissions caused by unintentional and deliberate injuries in children in Redditch, West Midlands and England (2015-16) ...... 98 Figure 67a: Hospital admissions caused by unintentional and deliberate injuries in children aged 0-4 years in Redditch compared to England; trend from 2010 - 2016 ...... 99 Figure 67b: Hospital admissions caused by unintentional and deliberate injuries in children aged 0-14 years in Redditch compared to England; trend from 2010 - 2016 ...... 99 Figure 68: Recorded diabetes; Redditch compared to England 2010-2015 ...... 100 Figure 69: Chlamydia detection rates in 15-24 year olds in Redditch compared to England, per 100,000 population ...... 101

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Redditch Needs and Assets Profile 1. Foreword

This document provides an overview of the Health Profile of the population of the Redditch District in Worcestershire. The purpose is to provide an overview of contemporary health and wellbeing in Redditch in the context of regional and national averages, to report variation, to identify areas of good performance and to highlight priority areas for strategy and action development. The focus is on local priority issues identified through evidence and consultation with key stakeholders and the provision of recommendations to improve specific health and wellbeing outcomes.

The profile supports the Worcestershire Joint Strategic Needs Assessment (JSNA), the Joint Health and Wellbeing Strategy 2016-21 priorities, and Redditch priorities.

Joint Health and Wellbeing Strategy 2016-21 priorities: i. Being active at every age; ii. Good Mental health and wellbeing throughout life; iii. Reducing harm from drinking too much alcohol across all ages.

Redditch local strategy priorities: i. Maternal and Early Years Health ii. Obesity iii. Mental health and Wellbeing throughout life iv. Ageing Well v. Reducing harm from drinking too much vi. Improving attainment and aspirations in young people vii. Support and enhance youth activities for young people in Redditch

The profile describes the demographic and social characteristics of the people who live in Redditch, before presenting additional detail on specific population sub-groups of interest. It also sets out to provide an overview of health behaviour patterns in the district, and the wider determinants of health and wellbeing. The patterns of major causes of mortality and morbidity are reviewed, with the key priority areas identified.

This document draws on evidence from a variety of national and local sources including information obtained from the Office for National Statistics (ONS), Public Health England (PHE) and reports prepared by Worcestershire County Council and Redditch and Bromsgrove Clinical Commissioning Group (CCG).

Detailed information on local JSNA publications for Worcestershire is available at: http://www.worcestershire.gov.uk/homepage/109/joint_strategic_needs_assessment

A series of Health and Wellbeing Profiles for the districts of Worcestershire are available on the Worcestershire JSNA website: http://www.worcestershire.gov.uk/downloads/download/572/joint_strategic_thematic_needs_ assessments_and_profiles

Public Health England also produces a series of Health Profiles for all upper and lower tier local authorities in England, available at: https://fingertips.phe.org.uk/profile/health-profiles

The Redditch Health Profile can be accessed via this link: http://fingertipsreports.phe.org.uk/health-profiles/2017/e07000236.pdf

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Redditch Needs and Assets Profile

This publication was prepared by Sebastien Baugh (Public Health Specialty Registrar), Worcestershire County Council.

Support, advice and guidance have been provided by the following to complete the Health Needs and Asset profile:

Liz Altay, Worcestershire County Council Claire Mitchell, Worcestershire County Council Karen Wright, Worcestershire County Council Janette Fulton, Worcestershire County Council Cameron Russell, Worcestershire County Council Helen Broughton, Redditch District Council

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Redditch Needs and Assets Profile 2. Executive Summary

The health and wellbeing of the Redditch population is characterised by variation across the wards of the district. Although there are some areas with good health outcomes, there remain wards and areas characterised by a high level of deprivation and which rank among the worst health and wellbeing outcome measures in England. Existing strategies adopted by the Worcestershire Health and Wellbeing Board, the Redditch Partnership Executive Group and the Redditch Community Wellbeing Trust aim to tackle these issues. This health and wellbeing profile has taken a new approach by mapping and understanding the assets that Redditch has at its disposal as a district to support wellbeing.

The assets of Redditch Wellbeing

A number of key factors were identified as supporting wellbeing in Redditch. This included; the vast number of assets available throughout Redditch, both physical and non-physical assets; the association of these assets with Wellbeing; the associations, networks and collaborative approaches throughout Redditch; the strong community cohesion within the district; and the vast knowledge of assets in the community. This has resulted in key actions and recommendations to harness and build on the available assets in Redditch including: overseeing a wellbeing action plan using an asset based approach; and leading a social movement supporting and promoting wellbeing using the available assets.

Health Overview

The health of people in Redditch is varied compared with the England average. Life expectancy for both men and women is similar to the England average; 79 and 83.3 years at birth respectively. However, life expectancy is 9.1 years lower for men and 7.2 years lower for women in the most deprived areas of Redditch than in the least deprived areas. Key health measures where outcomes in Redditch are poorer than the national average are:

Adult Health  Recorded Diabetes  Excess weight in adults  Intentional self-harm in adults  Alcohol related admissions and harm in adults  Alcohol related cardiovascular disease conditions  Depression and common mental health disorders  Influenza vaccinations  Chlamydia Detection Rates in young people

Child and Maternal Health  Excess weight in children  Breastfeeding initiation  Self-harm in children and young people

Wider determinants of health

The health and wellbeing of individual people and communities is affected by a wide range of factors including the natural and built environment, housing, local economy, educational opportunities and community networks. Specifically we have identified these wider issues as a concern in Redditch:  The rate of violent crime is worse than average

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Redditch Needs and Assets Profile

 There are a higher proportion of people living in most deprived areas in the country compared to England  Education attainment across certain wards in Redditch is below England average

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Redditch Needs and Assets Profile 3. Methods

A range of methods were undertaken to complete this Health and Assets profile for Redditch district. It was envisaged that the addition of an assets based approach to the profile would enable and empower the audience and reader to make the most of the assets and build on them into the future. Furthermore, the profile includes an assessment of need within Redditch based on previous, current and future data projections. This included quantitative and qualitative data collection, analysis and interpretation. This supported the development of the data compendium of this profile. This profile was completed between August 2017 and December 2017

3.1. Assets of Redditch: data collection, analysis and interpretation

A number of engagement activities, including one main workshop, were undertaken to map the available assets in Redditch and facilitate an assets based approach to Wellbeing. The Redditch Partnership Executive Group (RPEG) and Redditch Community Wellbeing Trust (RCWT) were engaged in the process from the outset of the inception of an assets based approach in the district. Both groups agreed that 'Wellbeing' should be the focus of the assets approach. Additionally, this aligned with the joint health and wellbeing strategy priority of 'Good Mental health and wellbeing throughout life'.

The main workshop, Mapping Mental Wellbeing Assets in Redditch, took place on the 12th October 2017 at Redditch Town Hall. Twenty two people were in attendance at the workshop which included a range of key stakeholders:  Community and voluntary sector organisations: adults, young people and children  Statutory health organisations  Police

The New Economics Foundation 'Five Ways to Wellbeing'1 was used as an evidence based framework to structure conversations throughout the day, prompting attendees to consider the five key domains of the model:  Connect  Keep Learning  Be Active  Give  Take Notice

The workshop was structured into three key sessions to enable data collection:

Mapping the assets: This session focused on attendees discussing and mapping what assets were available in Redditch; related to wellbeing. Mapping is a powerful and fun visual aid. It supported bringing together information about the assets in an alternative engaging format for this profile.

What creates Wellbeing in Redditch?: The main aim of this session was to understand the facilitators and barriers (driving and resisting forces) to Wellbeing in Redditch, and what are the solutions to address this. Discussions focussed on how the assets identified in the previous session supported an asset-based approach in Redditch.

Building on the assets: This final interactive session aimed to create the action for Redditch, in achieving an asset based approach.

The findings from this workshop are in section 4.

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Redditch Needs and Assets Profile

3.2. Quantitative data collection, analysis and interpretation

Appropriate routine data sources and service activity data were searched and used to establish the health need in Redditch, in addition to identifying and reporting on aspects of the wider determinants of health. This included: ● Public Health Outcomes Framework (PHOF) ● Hospital Episode Statistics (HES) ● Quality Outcomes Framework (QOF) ● NHS RightCare ● Office of National Statistics (ONS) ● The Department for Education ● Population.city ● Census 2011 ● Indices of Multiple Deprivation (IMD) 2015 ● Public Health England – Shape Atlas ● Annual Population Survey 2016 ● Local Health ● Active Lives Survey, Sport England ● Department for Transport ● National Child Measurement Programme (NCMP)

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Redditch Needs and Assets Profile

Part One: Assets in Redditch

Part One: Assets in Redditch

www.worcestershire.gov.uk/jsna

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Redditch Needs and Assets Profile 4. An Asset Based Approach in Redditch

4.1. Mapping the assets

A vast number of assets were identified through the mapping exercise. They included a wide variety of assets including physical assets, networks, associations, opportunities and Redditch district's green open spaces. These assets have been stratified into groups using the 'Five Ways to Wellbeing' framework. This will facilitate identification of assets based on the requirements of an individual or organisation; for example, if a frontline practitioner or social prescriber identifies a need in an individual they are interacting with that requires attention, such as social isolation, they can use the 'Connect' map to identify keys assets throughout the district that may be appropriate for that person. Similarly, organisations may wish to understand the opportunities to develop further skills and facilitate growth in their workforce by utilising the 'Keep Learning' asset map.

There are 4 asset maps covering all domains of the 'Five Ways to Wellbeing' framework. Given the overlap of key aspects of the framework, the following domains are mapped together:  Be active  Connect  Keep learning  Give and Take notice

Each map includes a key to identify the asset location in Redditch. Section 4.4 has further information regarding the assets and links to the assets website.

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Redditch Needs and Assets Profile Be active map

1. Morton Stanley park (plus take notice) 2. Abbey Park Sports Centre and outdoor green space (plus take notice) 3. Arrow Valley County Park (including take notice) 4. Redditch Rugby, Hockey and Cricket club 5. Abbey Stadium Sports Centre 6. Gymnastics Inkberrow 7. NOLIMITZ Trampoline Park 8. Parkrun Arrow Valley 9. Redditch Boxing Academy 10. Wheels Project

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Redditch Needs and Assets Profile Take notice / Give map

Give 1. Church Hill Big Local Partnership 2. Redditch Food Bank 3. Redditch Night Stop 4. The Oasis Christian Centre 5. The Space Winyates

Take Notice 6. Forge Mill Park and Museum (plus learn) 7. Palace Theatre (plus learn) 8. Redditch Bandstand (plus connect / learn) 9. Arrow Valley County Park (BA) 10. Indigo Arts 11. Redditch Mental Health Action Group 12. Worcestershire Wildlife Trust

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Redditch Needs and Assets Profile Connect map

1. Church Hill Big Local partnership 11. The Bridge (plus learn) 12. Carers Careline 2. Sandycroft Centre (plus learn) 13. Radiate Redditch (homelessness) 3. Redditch Youth and Community 14. Boys2Men Enterprise 15. The Redi Centre 4. Batchley Support Group (plus 16. Webheath Village Hall learn) 17. What's Your Point? 5. Alzheimer's Society Community 18. Windmill Community Centre Action Group 19. YMCA Worcester 6. Bromsgrove and Redditch Autism Support Group 7. Redditch Partnership 8. Feckenham Community Shop (G) 9. Holly Trees Children's Centre (L) 10. Redditch Youth and Community Enterprise

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Redditch Needs and Assets Profile Keep learning map

1. Redditch Libraries 2. Heart of Worcestershire College 3. Britten Street Hub Community 4. Older People Forum - Age UK 5. Woodrow library 6. District Home Start 7. HeadGym 8. Inspire Community Training C.I.C 9. Learningonline Redditch 10. Oakland Foundation 11. Batchley Support Group 12. Swanswell Alcohol and Drugs Recovery Service 13. Where Next Association 14. Worcestershire Healthy Minds

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4.2. What creates Wellbeing in Redditch?

An array of factors were identified as key to creating and adding to wellbeing in Redditch. As a collective and individually, the assets and factors all associated with achieving wellbeing for the population of Redditch. These factors were organised using the 'Five Ways to Wellbeing' framework and have been highlighted in bold as important influences:

Take Notice: Redditch has a number of physical assets such as outdoor space, parks and landmarks that can be utilised to 'take notice', enhance wellbeing and savour the moment to reaffirm life priorities. These places can be used by the residents of Redditch to; visit somewhere new that they have not yet explored in the district, take a different route back from work to take notice of differing environments and opportunities in Redditch. Taking notice can strengthen and broaden awareness. The asset mapping exercise for Redditch in fact shows the vast number of assets available for residents to be able to take notice. It does not necessarily have to be a physical asset. The strong community cohesion of the district can enable and facilitate the population to be more aware of their relationships around them, both formal and more informal relationships.

Give: An array of volunteering activities as well as opportunities to help others through providing support to the homeless or providing food through a food bank were key aspects of the Redditch offer to 'Give' within the five ways framework.

Connect: A strong theme that emerged from the asset based workshop was concerning the connections, associations and available networks in Redditch. Historically and anecdotally, this has been a strength for the district over the years. The community and voluntary sector has provided appropriate support for the population which has led to a substantial network of organisations and connections that are at the heart of the community. Connections built around individuals, communities, schools and workplaces support and enrich communities and populations every day. These can be seen as the cornerstones of life and evidence suggests appropriate investment of time should be put into developing them. A key factor to connecting people or organisations together is the knowledge of assets in the community to facilitate the connections. This is apparent throughout Redditch, but as discussed below, it is a factor that can further strengthened.

Be Active: Regular physical activity is associated with lower rates of depression and anxiety across all age groups. Additionally, exercise is essential for slowing age-related cognitive decline and for promoting well-being. Redditch has a vast range of 'be active' assets available to it as a district to support people to achieve this. This includes assets available for people to be physically active within the district, for example; taking part in one of the Arrow Valley Health Walks, available for all abilities; or getting involved senior circuits at the Abbey Stadium Sports Centre may be more suitable for someone. Whatever takes someone's fancy; there will be an activity available for them. This aspect of the framework links strongly with Connect. Having family members, colleagues, workplaces or networks motivate each other to be active can play a key role to sustained behaviour change from individual to population level.

Keep Learning: This domain of the framework associates itself with the availability of assets to ensure the residents of Redditch have the ability to commit to continued learning through life. This helps to enhance self-esteem, encourages social interaction and encourages a more active life. The range of libraries, museums, learn direct courses and organisations that offer workshops to develop new skills and provide an environment to keep learning are significant in Redditch. This can be seen in the framework below and the maps. It requires further harnessing to ensure this is utilised by the population of Redditch.

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In summary the key factors creating wellbeing in Redditch included: • the vast number of assets available throughout Redditch; including physical assets • association of these assets with Wellbeing • associations, networks and collaborative approaches • a strong community cohesion • knowledge of assets in the community

The workshop also identified barriers to positive wellbeing in Redditch. This included:  Not making the most of the resources available in Redditch. For example, hiring rooms within community setting is known to be an issue for small community groups and organisations, however these community venues more often than not sit empty rather than being used. Suggestions were made to ensure that room hire or available assets throughout the district are fully utilised through cost neutral approaches.  As alluded to above, that the knowledge of assets is key to connecting systems together; this includes positive wellbeing in Redditch. This can be further improved as although at present it works well, there is room for improvement, most notably for the outdoor physical assets that Redditch possess (not many people know that Redditch was designed with accessibility and walking around the district in mind!)  Perceptions and aspirations of Redditch were deemed a barrier to positive wellbeing. This included that the aspirations of some communities are low, resulting in low self- esteem and self-efficacy. There are perceptions of poor statutory services by users. In combination this leads to a 'loss of faith' in the system for some communities.  Accessibility to services and barriers such as digital exclusion also have an impact on positive wellbeing throughout Redditch.

4.3. Building on the assets

The findings and feedback from the asset workshop event have led to a number of recommendations and actions for key partners (including RCWT and RPEG) to work towards to make the most of the available assets within Redditch. This should also include elements of work that build on the assets in the district. The key actions are covered below:

 Oversee a wellbeing action plan using an asset based approach: both RPEG and RCWT should oversee a wellbeing action plan that has an asset based approach as an integral part of the approach  Lead a social movement supporting and promoting wellbeing using available assets: A health social movement is a persevering people-powered effort to promote or resist change in the experience of health or the systems that shape it. This movement shifts power to patients and citizens, strengthens communities, improves health and wellbeing, and—as a by-product—helps support rising demands on health and care systems2. The NHS Five Year Forward View noted its importance moving forward in changing systems. Nesta have recently reported3 on key aspects of successful social movements. This includes: grow in influence by engaging the right people in the right places at the right time; focus on an important set of early actions including mobilising people, experimenting with effective strategies, deploying assets and resources creatively; understand the value of cultivating a diverse set of voices and the unique experiences, skills and interests they bring; make smart trade-offs about where and how to invest their energy in relationships to achieve the highest level of influence and impact. These key learning points should be considered when planning this approach for Redditch.

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 Consider how to use schools, colleges and other educational settings as an asset; and consider what an asset based approach within schools looks like: schools play an important role in communities and within children and young people's lives. The workshop identified that due consideration should be given to how schools as assets can support positive wellbeing in Redditch.  Agree a cost-neutral approach for the use and sharing of available assets (e.g. no charges for room hire): This will support and facilitate utilising assets across the community at rates that are more affordable for all organisations and make the most of what's available in Redditch.  Share asset profile with partners considering the various communication channels, disseminating the work that has been undertaken to understand the assets across Redditch.  Actively utilising YLYC and Redditch and Bromsgrove Wellbeing websites to promote available assets; using this communication channel to enhance the knowledge of the available assets in the wider community.  Consider how to upscale connectivity and networks between assets; this will build on the strong theme identified within Redditch.  Utilise and build on the assets identified, within the local social prescribing model: social prescribing is being rolled out across Worcestershire. Assets identified through this report and the workshop should be available for the social prescribing model and service users that engage with the service  Use the five ways to wellbeing as a framework at strategic, community and individual levels: The 'Five Ways to Wellbeing' is an evidence-based approach to improving wellbeing at all levels. The framework can be used to facilitate and support this approach across Redditch.  Consider how to make better use of outdoor spaces: Redditch is surrounded by many outdoor spaces, identified through the mapping exercise. However, there was a consensus that more could be made of these outdoor spaces. Collaborative work should be undertaken to get an understanding about how best to harness these assets  Building on the assets identified, particularly the partnership working and strong local community cohesion, this will build on what is a strong theme and facilitator for the assets in Redditch.  Continue to upscale volunteering and wellbeing champions: This provides residents of Redditch to 'Give' their time and volunteer, a key part of the Five Ways to Wellbeing.

These actions have been presented to the Redditch Partnership Executive Group (RPEG). It was agreed that some of the actions may be incorporated into the RCWT’s Health and Wellbeing Action Plan. This will be scoped by further work with RPEG and RCWT in the New Year.

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Redditch Needs and Assets Profile 4.4. The assets in Redditch

Abbey Stadium Sports Centre - Local community activity centre with a range of activities for all ages and all abilities including specific memberships for younger and older people.

Action For Children – it supports families within Worcestershire. It works in partnership with families to offer Targeted Family Support, Parenting and community development.

Alexandra Hospital - The hospital is the major centre for the county’s urology service. The hospital has eight operating theatres, MRI and CT scanners and cancer unit status for breast, lung, urology, gynaecology and colorectal cancers. There is a multi-disciplinary education centre with library, teaching and study areas.

Alzheimer's Society Community Action Group - Redditch & Bromsgrove Dementia Friends Together are a group of people from the communities of Redditch & Bromsgrove living well with dementia. We are working to support and inspire communities & Businesses to become dementia friendly.

Arrow Valley County Park - At 900 acres Arrow Valley Country Park is the largest area of open space in Redditch. Includes a range of activities and opportunities including a visitor centre.

Batchley Support Group - social and learning activities for local residents in the borough of Redditch

Britten Street Hub Community - Custodians of the historic Old Needle Works building and turning the space from an industrial setting, with harsh backgrounds, into a thriving and inviting Craft Centre and haven for independent small business to flourish. There are a variety of creative, learning, wellbeing and specialist services to the local community and wider.

Boys2Men - Boys2Men take lads and their dads on a range of challenging, fun and adventurous activities, strengthening the bond between them and helping them to trust each other more.

Bromsgrove and Redditch Autism Support Group - The autism spectrum disorder (ASD) Support Group for Redditch and Bromsgrove meet every 2nd Wednesday of the month, from 8pm-10pm, for parent meetings. We have a variety of speakers attend the meetings and have meetings where parents have opportunities to chat and exchange ideas. We also organise family activities once a month, usually on a weekend.

Bromsgrove and Redditch Open Places - a new initiative that’s trying to bring together anyone who has an interest in the open spaces of Bromsgrove and Redditch. Open spaces are anything from country parks to allotments, nature reserves to community gardens, pathways to playing fields. We want to create a network where groups can help each other, volunteers want to get involved, and young people can get excited about the outdoors.

BARN (Bromsgrove and Redditch Network) - a network supporting volunteers and community organisations across Bromsgrove and Redditch. They are the voice of the voluntary sector, support local communities, and help with networking, information, funding and volunteering.

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Redditch Needs and Assets Profile Carers Careline - if you feel cut off from the information you desperately need, stressed, isolated or overwhelmed in your caring role and live in the Redditch area, then Carers Careline aims to help you tackle all these issues and more

Citizens Advice Bromsgrove and Redditch - provides free, confidential and impartial advice and campaign on big issues affecting people's lives with a goal to help everyone find a way forward, whatever problem they face.

Church Hill Big Local Partnership - The Big Lottery Fund has made an award of £1million to the district Church Hill in Redditch on the basis that it was an area with needs that had previously been overlooked for receiving lottery money. The project is called the Big Local, overseen by The Local Trust. This money is allocated by the Big Lottery Fund to bring together local talent, ambitions, skills and energy from individuals, groups and organisations who want to make their area an even better place to live.

Couch 2 5K - Want to ditch the couch and start running? The courses are designed for absolute beginners or for people wanting to be more active again, it iis an easy way of getting fitter and healthier

CRUSH – It is a structured programme of group support and empowerment for young people of the age range 13 to 19 who have witnessed, experienced or are at risk of domestic abuse

Dial - disability information advice line - an independent, free, impartial and confidential information, advice and welfare benefit service for disabled people, their families, carers, friends and relevant professionals.

District Home Start - Home-Start is one of the leading family support charities in the UK. Home-Start volunteers help families with young children deal with the challenges they face. The charity supports parents as they learn to cope, improve their confidence and build better lives for their children.

Dr Barnardos - Short breaks for disabled children: Short breaks, providing sitter services, befriending and individual support. Emphasis on building confidence and independence through inclusive play, play/holiday schemes and enabling social inclusion and skills.

Feckenham Community Shop - Designed to be a convenient meeting place and focal point for the local community, it is run by an enthusiastic and committed group of volunteers who provide a warm welcome and a friendly, personal service.

Forge Mill - learning opportunities with wonderful resources that can be used to enhance any pupil's learning experience. There are children’s and adults workshops, also talks.

Gymnastics Inkberrow – the club is located in the heart of Worcestershire and provides gymnastics for all ages and abilities.

HeadGym – the belief that mind and body are equally important and concentrating on getting your head into shape, using a combination of the best training, coaching and personal development methods to make sure you get the life you want.

Heart of Worcestershire College (Redditch Campus) - a further and higher education college that offers full time and part time courses in a diverse range of specialist subject areas. From courses for school leavers to affordable higher education and professional qualifications, we ensure our training is relevant to significantly improve employability prospects.

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Redditch Needs and Assets Profile

Holly Trees Children's Centre - parenting and family support Service for you and your family

Indigo Arts - an Arts Charity working to increase the accessibility of high quality arts provision to the whole community by whatever means possible. Over the last 15 years Indigo has funded highly successful projects, performances and workshops in a variety of arts/performing arts disciplines.

Inspire Community Training C.I.C. - the centre offers a large range of vocational courses, with accredited NOCN or BTEC qualifications and non-accredited recreational courses. It is small and friendly and supports learners to gain nationally recognised qualifications.

Jestaminute Theatre Company – the community theatre company and group in Redditch

Learningonline Redditch - Return to work or education by improving your skills and building confidence, courses in computers, English and maths at the Greenlands Business Centre

Morton Stanley Park - The 95 acres of Morton Stanley Park offer a rich mosaic of natural habitats and things to do, amidst a historic landscape of open mown grass, veteran trees and mature hedgerows, includes: equipped play areas; skate park; zip wires; turnfly (inverted, rotating see-saw!); grass football pitches; woodland walks

NewStarts – it is a Christian community re-use social enterprise base in Bromsgrove whose passion is to help people overcome the challenges and disadvantages that shape their lives and in doing so show them the love of God. The core activity is to provide free furniture, emergency food and household supplies to families and individuals who are in greatest need either on low incomes or in financial crisis.

NOLIMITZ Trampoline Park – a great place to have fun and keep active.

Oakland Foundation – it was formed in 2012 by Redditch family business Oakland International after statistics showed that three wards in Redditch featured in a list of the ten most deprived wards in Worcestershire. Two more Redditch wards just missed the top 10.The Foundation’s primary objective is to relieve the needs of children in Redditch and Bromsgrove and the surrounding area. The Foundation focuses on activities based in the areas of education, sport, health and nutrition.

Oasis Centre Foodbank- we work closely with our community partners: the Redditch Food bank, part of Acts of Kindness (AOK).

Older People Forum - Age UK - Age UK Bromsgrove, Redditch & Wyre Forest is a charity which supports older people across the districts of Bromsgrove, Redditch and Wyre Forest. The staff and volunteers are dedicated to promoting wellbeing and independence for over 50s, ensuring later life is a fulfilling and enjoyable experience.

Onside Advocacy - Worcestershire based charity established in 1993 stemming from a belief that everyone has the right to be a valued human being and to be treated in a just and fair manner. In support of this belief we provide a range of support and services to ensure fairness and equality for adults who may be vulnerable, disadvantaged, discriminated against. This includes mental and physical ill health, sensory impairment, learning disability, drug and alcohol misuse, older people, and carers.

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Redditch Needs and Assets Profile Palace Theatre - the Palace is a 420 seat theatre with a Grade II listed auditorium, situated in the heart of Redditch’s town centre. Our programme reflects a wide and varied choice of entertainment, check out our What’s On Guide for a full listing of forthcoming attractions.

Parkrun Arrow Valley – it is a FREE weekly 5km event for runners of all standards, which takes place every Saturday. It is not a race against other runners, but a 5k timed run and it can be whatever you want it to be, whether that's for fun or as part of a training plan

Radiate Redditch - provides a winter day and night provision for those who are homeless or for those individuals who are alone and isolated during the festive season.

Reach 4 Wellbeing - part of the Starting Well Service in Worcestershire promoting and supporting emotional wellbeing for children and young people aged 5-19 years old. There is a team of 7 staff

Redditch Bandstand - Redditch town centre’s beautiful bandstand hosts events all year round including the summer Bandstand Festival. It’s also available to book for performances. Built in Church Green in 1883 alongside the Bartleet Fountain during major improvements to that part of Redditch, the bandstand’s character has been preserved throughout 130 years of improvements and updates. The bandstand is octagonal with brick balustrades all the way round, overhanging eaves, a concrete floor, and downlighters. We have a strong belief in the power of sport to encourage personal discipline and lead people to live happier

Redditch Boxing Academy – the Academy was set up in 2013 as a not-for-profit community interest company. The primary aim is to use sports recreation as a way to promoting health and well-being and encourage sustainable positive outcomes.

Redditch and Bromsgrove Dementia Friends Together - a leadership group made of people living in Redditch and Bromsgrove who are diagnosed with dementia. They meet weekly to support each other and find ways to improve services and attitudes and to make a better and fairer world for people living with dementia in our local community.

Redditch Central Mosque - It is in the town centre area of Redditch run by the Redditch Mosque Committee, and is one of the largest Muslim centres in Redditch. The mosque is open to people of all religious affiliations men and women,

Redditch Food Bank – it provides three days nutritionally balanced emergency food and support to local people who are referred to the food bank in crisis. It is part of a nationwide network of foodbanks, supported by The Trussell Trust, working to combat poverty and hunger across the UK.

Redditch library – local library in the heart of Redditch

Redditch Martial Arts and Fitness - martial arts and physical fitness classes for all ages and abilities.

Redditch Mental Health Action Group – RMHAG was set up in May 2013 with the aims of fighting for better mental health services and tackling stigma. The action group is currently aiming to become a charitable organisation with all donations going towards mental health projects in the town

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Redditch Needs and Assets Profile Redditch Night Stop - a voluntary organisation which, since it was set up in 1997 to provide emergency accommodation, has evolved to provide a wide range of service for young people who may be at risk of homelessness in the Redditch area.

Redditch Partnership - it brings together representatives from public, private, community and voluntary agencies to work together effectively to deliver a range of local projects, services and initiatives. Redditch Partnership aims to provide a leadership and governing role through sharing information, resources and effort to efficiently and effectively meet the needs and aspirations of local communities.

Redditch Relate - Relate Worcestershire has been delivering relationship support services to people of all ages, backgrounds and sexual orientations in Worcestershire for over 50 years.

Redditch Royal Voluntary Transport Service - Community Transport volunteers are needed to help older people get out and about to stay engaged with their local communities. Typical journeys may include driving someone to a GP appointment, driving them to the shops, taking them to a social club or to visit friends and family.

Redditch Rugby, Hockey and Cricket club – sports club and ground offering sporting opportunities for all abilities

Redditch Talking Newspaper – to provide local blind, partially sighted and disabled people with digital players in order for them to receive and listen to weekly memory sticks provided by the newspaper containing local news and other useful information including local and national government bulletins on social matters, community safety, environment, transport and leisure.

Redditch Town Centre Partnership CIC - Management consultancy activities other than financial management

Redditch United Football Club - ‘The Reds’ is one of the longest established football clubs in the Midlands, starting out as Redditch Town in the Birmingham Combination League in 1891 and being crowned first winners of the Worcestershire Senior Cup in 1894

Redditch Youth and Community Enterprise - provide affordable room hire in a well maintained, well resourced, safe and secure building. Within which a range of community organisations can come together to offer a varied and exciting programme of activities for all age groups and members of the Redditch community.

St Andrew's C of E Primary School – the school provides extended care for pupils outside of normal school hours when required by parents/guardians. Both the breakfast and after school club (Kids Club) are staffed by teaching and mealtime assistants employed by the school

Sandycroft centre - Situated in Smallwood in Redditch, the Sandycroft Centre (Formally the All Women’s House) offers a wide range of services to support the Redditch community. The Sandycroft Centre works with other agencies to provide local services to meet the needs of a diverse community through a ‘One-stop-shop’ approach.

Seek and Reach Project - Young Solutions Worcestershire is a new breed of charity – enterprising, commercially astute and passionate about ‘Keeping Young People Safe and

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Redditch Needs and Assets Profile Involved’. We aim to be Worcestershire’s premier charity working with young people; the ‘go to’ organisation that uniquely bridges the ‘for profit’ and ‘not for profit communities’.

SHAPE -Supporting Health and Promoting Exercise - Overseen by a team of clinical and academic experts on mental health, lifestyle behaviours and physical activity, SHAPE content provides an evidence based approach to promote healthy lifestyle behaviours for individuals with serious mental illness.

Smallwood House Redditch - Smallwood House provides a free and confidential service to people of all ages and backgrounds. You will not be judged in any way and your concerns will always be dealt with in a sensitive manner. All methods of contraception available, pregnancy testing and sexual health advice.

Swanswell Alcohol and Drugs Recovery Service - delivering services as part of the Worcestershire Recovery Partnership, offers advice and information, medical and psychological treatment and access to residential rehabilitation

The Bridge Church - cafe and charity shop, toddlers and mothers group, traditional cafe church, Age UK activities, cinema club and foodbank

The Ecumenical Centre - a multi-use safe space providing community services and a morning coffee shop

The Girls' Network - mentoring charity – launched in Redditch; it aims to raise the aspirations of girls from disadvantaged backgrounds and to inspire girls aged 14 to 19 to be ambitious and reach their potential by matching them with a professional female mentor.

The Oasis Christian Centre – works closely with the community partners: the Redditch Food- bank, part of Acts of Kindness (AOK)

The Redi Centre at the centre, RYCE (The Redditch Youth and Community Entrerprise) aim to provide affordable room hire in a well maintained, well resourced, safe and secure building. A range of community organisations can come together to offer a varied and exciting programme of activities for all age groups and members of the Redditch community.

The Space Winyates - a friendly supportive group who welcome all newcomers and endeavour to make everyone feel at ease with a cuppa and a listening ear. Problems discussed are wide ranging including finance, housing ,health, work and relationships. The aim is to capture everyone’s experience, both good and bad, and share with each other. It is surprising how much the experience of one group member can help another. A true peer support group.

The Young Firefighters Association - the new members take a 13-week training course before participating in a passing out parade. This is a chance to demonstrate the skills that they have learned to friends, family, local dignitaries and senior Fire Service officers.

Time to change – the growing social movement changing how we all think and act about mental health. Still too many people are made to feel ashamed or isolated because they have a mental health problem but the campaign is here to change that.

Two Pennies money advice - independent local money advice agency working in the county of Worcestershire from premises in Worcester. It helps people who are having problems with money and debt.

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Redditch Needs and Assets Profile

Victim Support - an independent charity for people affected by crime and traumatic incidents in England and Wales. Our specialist teams provide individual, independent, emotional and practical help to enable people to cope and recover from the effects of crime.

Walking in Redditch - the aim of the site is to develop walks related to Redditch history and existing historical artefacts and buildings.

Webheath Village Hall – it offers excellent facilities which appeal to meeting groups or seminars, activity groups, parties and other organised associations.

West Mercia Rape and Sexual Abuse Support Centre - WMRSASC is a free, confidential and non-judgemental support service for survivors who have experienced rape, assault, incest, sexual abuse, sexual harassment or any form of sexual attack, whether physical, verbal or emotional.

What's Your Point? - it is a not-for-profit organisation providing support to children and families who have social and emotional needs. The Bryant Place Centre in Woodrow Redditch provides a focal point in the community, and a physical base from which many of our activities and services are delivered.

Wheels Project - One of the U.Ks largest outdoor supervised Charity Skateparks for BMX, Inline Skating, Skateboards and Scooters; ramp courses from the beginner to the pro rider; hosting some great events throughout the year.

Where Next Association - providing care, support, work experience and training to adults with learning disabilities or those disadvantaged in some way.

Willow Trees Community Centre - A community facility in Church Hill, Redditch, managed by the YMCA Worcestershire in partnership with Redditch Council.

Windmill Community Centre – it is a base for local groups including Windmill pre-school, Multiple Sclerosis group, Starlight Dance School and various exercise classes and social groups.

Woodrow library – a range of library services available locally.

Worcestershire Association of Carers - a registered charity that was founded in 1997 providing an independent source of information, advice and support for unpaid adult carers in Worcestershire. It provides representation for carers at a local and national level and support carers to have a voice in decisions that affect them.

Worcestershire Healthy Minds – it supports people aged 16 and over who are experiencing problems such as stress, anxiety, low mood and depression. It helps people improve their mental wellbeing through a range of interventions such as short courses, online therapies, and guided self- help.

Worcestershire Wellbeing Hub - an information and signposting service for people over the age of 16 who are experiencing low mood, anxiety or stress, and feel that they would benefit from support from local community providers.

Worcestershire Wildlife Trust - it carries out practical conservation work on its reserves across the county to maintain their value for wildlife.

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Redditch Needs and Assets Profile

Worcestershire Young Carers >25 – it aims is to support children and young people age 7 to 25 years who help to look after a parent, guardian or sibling within their home, who is ill or has a disability. This includes caring for people who have issues with drugs or alcohol or have a mental health difficulty

YMCA Worcester – it enables people to develop their full potential in mind, body and spirit. Inspired by, and faithful to, our Christian values, we create supportive, inclusive and energising communities, where young people can truly belong, contribute and thrive.

Your ideas youth and community project - Your Ideas work with a range of young people from a variety of backgrounds. We offer a safe, nurturing and supportive environment for children, young people and young adults to gain confidence and positive coping strategies by trying new things, building positive relationships and having fun.

Part Two: Needs pro

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Redditch Needs and Assets Profile

Part Two: Needs profile in Redditch

www.worcestershire.gov.uk/jsna

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Redditch Needs and Assets Profile 5. Redditch Overview

5.1. Geography and wards of Redditch

Redditch District is situated in the north-east of Worcestershire. It borders the region of Birmingham and many people live in the Redditch area and commute into Birmingham or Worcester. It has a younger age profile compared with Worcestershire which is similar to that of England. As a district, it is less healthy and less affluent than the national average. Redditch is a predominantly urban area in the north of the district. This changes in the south of the district as it becomes predominantly rural. Figure 1 show the wards and ward boundaries in Redditch district.

Figure 1: Wards and ward boundaries of Redditch district

Source: www.redditchbc.gov.uk Ward map of the borough

1. Abbey Ward 2. Astwood Bank & Feckenham Ward 3. Batchley & Brockhill Ward 4. Central Ward 5. Church Hill Ward 6. Crabbs Cross Ward 7. Greenlands Ward 8. Headless Cross & Oakenshaw Ward 9. Lodge Park Ward 10. Matchborough Ward 11. West Ward 12. Winyates Ward

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Redditch Needs and Assets Profile 5.2. Population

Redditch has a population of 84,971 which accounts for approximately 14.7% of Worcestershire's total population of 575,500 (ONS mid-year population estimates 2016). This is only a slight increase in population for Redditch since 2011 (84,318) and figure 2 reveals the recent plateau of population levels within the district since 2010. This is in contrast to Worcestershire's population that is rising and has increased by approximately 8,000 since 2011. Appendix one demonstrates the population variables for Redditch including births, deaths and migration data for 2016. It shows the small 0.27% increase in population since the mid-year population estimates in 2015.

Figure 2: Population history in Redditch since 1980

Source: Population.city, Accessed October 2017

Figure 3 shows the population projections in Redditch until 2039. This entails an increase in population of approximately 1,500 which equates to 1.76%.

Figure 3: Population projections in Redditch until 2039

Source: Office of National Statistics

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Redditch Needs and Assets Profile 5.2.1. Birth rates and fertility

General Fertility Rate is defined as the rate of all live births per 1,000 in women of child bearing age, 15 to 44 or 49 in some data sets. The GFR in Redditch is within close range of the regional and national comparative rates – figure 4. Along with Wyre Forest, it is one of the higher rates in Worcestershire compared to other districts.

Figure 4: General Fertility Rate (GFR) – all live births per 1,000 women aged 15-44 by area in 2016

80 70 60 50 40 30 20 10

0 GFR (live GFR(live births per 1,000 women)

Area

Source: Office of National Statistics

When comparing the birth rates in the under 18s Redditch has a higher rate than three of the other Worcestershire districts: Bromsgrove, Malvern Hills and Wychavon (figure 5). Due consideration must be given to the fact that this is a crude rate. Redditch also has a statistically significant higher under 18s rate compared to the England national average. It is twice as high at a rate of 12 per 1,000 compared to 6 per 1,000 in England.

Figure 5: Under 18s birth rates per 1,000 by area in 2015 (note, this is a crude rate) 20 18 16 14 12 10 8 6

Crudeperrate1,000 4 2 0 England Bromsgrove Redditch Malvern Worcester Wychavon Wyre Forest Hills Area

Source: Public Health Outcomes Framework

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Redditch Needs and Assets Profile Figure 6 represents the under 18s birth rates trend from 2009 – 2015. This shows that the trends have not been stable over the last few years, however as the rates represent low number of births, a difference of seven births per 1,000 represents a significant change in the data. From 2014 to 2015 the number increased from 7 to 12 per 1,000 per year.

Figure 6: Under 18s birth rates per 1,000 trend from 2009 - 2015 in Redditch and England 20 18

16 14 12 10 Redditch 8 6 England Crudeperrate1,000 4 2 0 2009 2010 2011 2012 2013 2014 2015 Year

Source: Public Health Outcomes Framework

Figure 7 below shows the birth rate in Redditch by IMD Decile. It shows higher rates in IMD 1-5 compared to other areas, a rather different pattern to the steady decline by IMD seen in the county as a whole. This may however be due to the uncertainty around the data as shown by the wide error bars in the graph.

Figure 7: Birth rate in 2014 per 1,000 women aged 15-44 by IMD decile (2015 – 1 being the most deprived area and 10 being the least deprived)

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Redditch Needs and Assets Profile 5.3. Age

Redditch has a considerably younger population than Worcestershire as a whole. Figure 8 gives a breakdown of the percentages of population in Redditch through to a national perspective.

In Redditch, 56.8% of the total population are aged 44 and under, compared with 50.5% for Worcestershire. The age groups 0-15 (18.8%) and 30-44 (20.5%) are above regional and national averages. However, those aged between 16-29 make up 17.5% of the population, similar to Worcestershire, but below national average (19.1%). Consequently, there are far fewer people aged 65 and over in Redditch in comparison with Worcestershire, 17.2% and 22% respectively.

In comparison to the 2013 health profile, the most significant change to the Redditch population profile is the increase in people aged 65 and over by 2.9%.

Figure 8: Percentage of population by age groups in 2016, mid-year population estimates

0-15 16-29 30-44 45-64 65 and over

Redditch 18.8% 17.5% 20.5% 26.0% 17.2%

Worcestershire 16.6% 16.5% 17.4% 27.6% 22.0%

Region West Midlands 18.4% 19.5% 18.5% 25.2% 18.3%

England 18.0% 19.1% 19.6% 25.4% 17.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage

Source: Office for National Statistics, Mid-year population estimates, 2016

Figure 9a and 9b shows the population pyramids for both Redditch and Worcestershire. This graphically represents the differing structure of the populations. Redditch appears to have a stationary population structure, compared to a constrictive population structure in Worcestershire. This can be seen through Worcestershire's narrower population total number in the lower age bands. Redditch has a reasonably equal structure at young ages and up to 55-60 age bands. The dependency ratio in Redditch is currently the same as national levels: 60.7%. This compares with Worcestershire's dependency ratio of 68.1%. Although in general Redditch has a younger population than Worcestershire, the graph shows a reduction in population between approximately 10-20 years of age. This could have an impact on the

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Redditch Needs and Assets Profile future dependency ratio, reducing the number of people able to contribute to the workforce and who can support the dependent population. This could also have an impact on the population that are actively contributing to the local economy within Redditch.

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Redditch Needs and Assets Profile Figure 9a: Population pyramid for Redditch, 2016

Figure 9b: Population pyramid for Worcestershire, 2016

Source: Office of National Statistics

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Redditch Needs and Assets Profile

5.4. Ethnicity

Figure 10 below compares the population of Redditch against that of Worcestershire, the West Midlands and England by broad ethnic group. Due to the frequency of data collection for ethnicity data, calculated by the census that takes place every ten years, there are no updates to this data since the last profile (2013).

Figures from the 2011 Census show that 92.0% of people in Redditch are from all White ethnic groups. This compares to 95.7% in Worcestershire, and 85.4% in England. The broad ethnicity group breakdown includes: 2% mixed ethnicity; 4.8% Asian / Asian British; 1% Black / Black British and 0.2% other ethnic groups. This breakdown is approximately double the representation when compared to Worcestershire, but considerably under national and regional ethnicity percentages.

Figure 10: Percentage of population by broad ethnic group in 2011

Figure 11 shows a breakdown of black and minority ethnic (BME) population by ward in Redditch. Abbey ward, Central ward and Lodge Park ward have the highest proportion of BME residents within the district; 15.8%, 22.3%, 14.9% respectively. This is in comparison to proportions of BME residents' equivalent to 3.7% of the ward population in Astwood Bank and Feckenham, Crabbs Cross, West Redditch and Church Hill.

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Redditch Needs and Assets Profile

Figure 11: Proportion of black and minority ethnic population by ward in Redditch

Source: Census 2011

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Redditch Needs and Assets Profile 6. Redditch Health at a glance

Public Health England (PHE) produces local Health Profiles each year which provide an overview of the overall health of the local population by district across England. This facilitates the identification of potential problems, in addition to areas that are performing well. This is in comparison with other local areas and with the national average. The Redditch summary includes:

Health in summary  The health of people in Redditch is varied compared with the England average  About 18% (3,000) of children live in low income families  Life expectancy for both men and women is similar to the England average; 79 and 83.3 years at birth respectively.

Health inequalities  Life expectancy is 9.1 years lower for men and 7.2 years lower for women in the most deprived areas of Redditch than in the least deprived areas

Child Health  In Year 6, 21.4% (203) of children are classified as obese  The rate of alcohol-specific hospital stays among those under 18 is 36 per 100,000. This represents 7 stays per year. It has reduced significantly in Redditch over recent years and it is now comparable to national rates.  Levels of breastfeeding initiation are worse than the England average

Adult Health  The rate of alcohol-related harm hospital stays is 750 per 100,000, worse than the average for England. This represents 607 stays per year  The rate of self-harm hospital stays is 278 per 100,000, worse than the average for England. This represents 237 stays per year  The rate of people killed and seriously injured on roads is better than average  The rate of violent crime is worse than average  Rates of statutory homelessness and long term unemployment are better than average

A 'spine chart' health summary showing the difference in health between the area and the average for England for 30 indicators can be seen in figure 12. The analysis in this profile predominantly focuses on those areas for which Redditch is currently, or was previously, considered to be significantly worse than the England average.

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Redditch Needs and Assets Profile Figure 12: Redditch Health summary spine chart for key health indicators

Source: Public Health England – Health Profiles, 2017

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Redditch Needs and Assets Profile 7. Wider determinants of health

7.1. Deprivation

Figure 13 shows the pattern of deprivation in Worcestershire. The county as a whole is relatively less deprived than the national average, as depicted by lighter shading in the map. However there are pockets of relative deprivation in the urban areas of Worcester, Kidderminster (Wyre Forest) and Redditch. In addition there are some deprived rural areas, most notably in the north of Wyre Forest and in Wychavon district, to the north of Evesham.

Figure 13: Deprivation in Worcestershire

Source: Indices of Multiple Deprivation 2015

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Redditch Needs and Assets Profile Figure 14 shows the pattern of deprivation in Redditch. The wards of highest deprivation within Redditch are situated in the North of the district. The areas that are in the most deprived 10% of LSOAs nationally include areas in: Greenlands, Abbey Ward, Batchley and Church Hill. This is represented by the darker shading of red on the map below. However, Redditch has a wide socio-economic range, with some very affluent areas and the largest deprived areas in the County. The more affluent areas are situated in the south of the County.

Figure 14: Deprivation in Redditch

Source: Indices of Multiple Deprivation 2015

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Redditch Needs and Assets Profile Figure 15 below shows the percentage of population in Redditch living in areas at each level of deprivation compared to England. Redditch has a larger proportion of the population living in the most deprived quintile and the second least deprived quintile, both approximately 25% of the population in each respective quintile. When analysed in deciles, 25 out of 55 of the Redditch LSOAs are in the most deprived decile compared to 30 in the least deprived deciles of deprivation (Index of Multiple Deprivation).

Figure 15: Percentage of population in Redditch living in areas at each level of deprivation compared to England

Source: Public Health England – local health profiles

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Redditch Needs and Assets Profile 7.2. Education

7.3. Early Years Foundation Stage (EYFS)

A good level of development (GLD) is defined as: Children achieving at least the expected level within the areas of learning: communication and language; physical development; personal, social and emotional development; literacy and mathematics. The main purpose is to provide an accurate assessment of individual children at the end of the EYFS. The profile describes each child’s attainment against 17 early learning goals, together with a short narrative about their learning characteristics. There has been an upward trend of improvement across most wards since 2014, similar to the national trend. However, Lodge Park ward has had a significant reduction in children achieving GLD compared to previous years. Additionally, 9 wards are under the national average for achieving the GLD at EYFS, including: Abbey, Astwood Bank and Feckenham, Batchley & Brockhill, Central, Church Hill, Greenlands, Lodge Park, Matchborough and West. However, it must be noted that the majority of these wards have made good improvements since 2014 and five of those wards are within 5% of the England National average.

Figure 16: Percentage of pupils achieving a good level of development at the Early Years Foundation Stage; 2014 – 2017 by ward compared with National average 90%

80%

70%

60%

50%

40%

Percentage (%) 30% 2014 2015 20% 2016 10% 2017 0%

Ward

Source: Department for Education

45

Redditch Needs and Assets Profile

Figure 16a: Percentage of pupils achieving a good level of development at the Early Years Foundation Stage; 2014 – 2017 by district and region compared with National average

2014 2015 2016 2017 England Avg. 2014 England Avg. 2015 England Avg. 2016 England Avg. 2017 80

70

60

50

Percentage (%) 40

30

20 West Midland Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest Region / District

Source: Department for Education

Figure 16a shows the percentage of pupils' achieving a good level of development at the Early Years Foundation. Redditch, as a district, has below average attainment at this education level when compared to national averages. Redditch also has lower attainment at this level compared to other districts in Worcestershire over the years presented above.

46

Redditch Needs and Assets Profile

7.4. Key Stage One (KS1)

In 2016, the reporting of this indicator changed. The new expected standard is broadly equivalent to the old 2B but results from 2016 onwards are not directly comparable with previous years.

Figures 13 to 15 represent the percentage of pupils achieving expected standards at KS1 for reading, writing and maths respectively by ward in Redditch. This is compared with national averages in 2016 and 2017.

Only three wards met the national average for reading standards in 2016. This increased to five in 2017. However, there are a number of wards that are quite under the national average and much lower than other wards in Redditch, most significantly – Abbey and Lodge Park.

Figure 17: Percentage of pupils achieving expected standard of reading at KS1; 2016- 2017 by ward compared with National average

2016 2017 England average 2016 England average 2017

90%

80%

70%

60%

50%

40%

Percentage (%) 30%

20%

10%

0%

Ward

Source: Department for Education

47

Redditch Needs and Assets Profile

Figure 17a: Percentage of pupils achieving expected standard of reading at KS1; 2016- 2017 by district compared with National average and the West Midlands

2016 2017 England average 2016 England average 2017

90 80

70

60 50 40

Percentage (%) 30 20 10 0 West Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest Midlands Region / District

Source: Department for Education

Comparing attainment across districts reveals that Redditch had the lowest percentage of pupils achieving expected standard of reading at KS1 in both 2016 and 2017. Both years in Redditch are below national average.

48

Redditch Needs and Assets Profile With regards to writing standards at KS1, only Astwood Bank and Feckenham exceeded the national average in 2016. By 2017, six wards met or exceed national average in Redditch. Both Abbey and Lodge Park wards are the lowest performing areas within the district.

Figure 18: Percentage of pupils achieving expected standard of writing at KS1; 2016- 2017 by ward compared with National average

2016 2017 England average 2016 England average 2017

90% 80%

70% 60% 50% 40%

30% Percentage (%) 20% 10% 0%

Ward

Source: Department for Education

Figure 18a shows that Redditch had the lowest percentage of pupils achieving standards of writing at KS1 in 2016 across Worcestershire districts. Redditch had the second lowest percentage in 2017, but this was equal to national average and above regional average.

49

Redditch Needs and Assets Profile Figure 18a: Percentage of pupils achieving expected standard of writing at KS1; 2016- 2017 by district compared with National average and the West Midlands

2016 2017 England average 2016 England average 2017

80

70

60

50

40

30 Percentage (%) 20

10

0 West Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest Midlands Region / District

Source: Department for Education

50

Redditch Needs and Assets Profile With regards to maths standards at KS1, once again, only Astwood Bank and Feckenham exceeded the national average in 2016. By 2017, only three wards met or exceed national average in Redditch. Abbey ward is the lowest performing ward within the district.

Figure 19: Percentage of pupils achieving expected standard of maths at KS1; 2016- 2017 by ward compared with National average

2016 2017 England average 2016 England average 2017

90%

80%

70%

60%

50%

40%

Percentage (%) 30%

20%

10%

0%

Ward

Source: Department for Education

Comparing attainment across districts reveals that Redditch had the lowest percentage of pupils achieving expected standard of maths at KS1 in both 2016 and 2017 (figure 19a). Both years in Redditch are below national average.

51

Redditch Needs and Assets Profile Figure 19a: Percentage of pupils achieving expected standard of maths at KS1; 2016- 2017 by district compared with National average and the West Midlands

2016 2017 England average 2016 England average 2017

90

80

70

60

50

40

Percentage (%) 30

20

10

0 West Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest Midlands Region / District

Source: Department for Education

In summary, most Redditch wards are failing to achieve expected standards of reading, writing and maths at KS1 level. Abbey ward and Lodge Park ward are consistently lower than other districts in Redditch. This is consistent when comparing across Worcestershire districts.

52

Redditch Needs and Assets Profile 7.5. Key Stage Two (KS2)

In 2016, no wards achieved national average expected standards for reading, writing or maths in comparison to England. The closest ward to the national average of 53% was West ward with 46%. In 2017, Winyates ward was the only ward to exceed the national average of 61%.

Figure 20: Percentage of pupils achieving expected standard of Reading, Writing and Maths at KS2; 2016-2017 by ward compared with National average

2016 2017 England average 2016 England average 2017

70%

60%

50%

40%

30%

Percentage (%) 20%

10%

0%

Ward

Source: Department for Education

When comparing across districts, figure 20a, only Bromsgrove and Malvern Hills achieved or exceeded the national average for KS2 attainment in 2016. In 2017, this was the case for only Bromsgrove. Redditch district has the lowest percentages of achievement and attainment at KS2 in both 2016 and 2017 compared to other districts in the County.

53

Redditch Needs and Assets Profile

Figure 20a: Percentage of pupils achieving expected standard of Reading, Writing and Maths at KS2; 2016-2017 by Worcestershire district compared with National average

2016 2017 England average 2016 England average 2017

80

70

60

50

40 Percentage (%) 30

20

10 West Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest Midlands Region / District

Source: Department for Education

54

Redditch Needs and Assets Profile 7.6. GCSE

By the time pupils in Redditch sit GCSE exams, Redditch district performs better than the national and regional average – figure 17. Performance decreased in 2015, but it increased to 61.8% of pupils achieving A*-C English and Maths in 2016. England average in 2016 was 59.3%.

Figure 21: Percentage of pupils Gaining A*-C/9-4 English and Maths at GCSE by district and region 80

70

60 England

50 West Midlands Bromsgrove 40 Malvern Hills 30

Percentage (%) Redditch

20 Worcester Wychavon 10 Wyre Forest 0 2014 2015 2016 Year

Source: Department for Education (Note: These figures include all pupils resident in Worcestershire and attending LA maintained schools or academies whether in or out of county)

55

Redditch Needs and Assets Profile Figure 22 reveals the GCSE performance by ward. Astwood Bank and Feckenham, Batchley & Brockhill, Crabbs Cross, Headless Cross and Oakenshaw and West Wards have consistently performed over recent years in GCSE performance compared to national average, their averages exceeding national average percentages. Abbey, Central, Church Hill, Greenlands, Matchborough and Winyates were all under national average in 2016.

Figure 22: Percentage of pupils Gaining A*-C/9-4 English and Maths at GCSE by ward compared to England average

2014 2015 2016 2017 England average 2014 England average 2015 England average 2016 90%

80%

70%

60%

50%

40%

Percentage (%) 30%

20%

10%

0%

Source: Department for Education (Note: These figures include all pupils resident in Worcestershire and attending LA maintained schools or academies whether in or out of county) Note: England averages for 2014 and 2015 are overlapping on the graph above.

56

Redditch Needs and Assets Profile 7.7. A-Level

Performance at A-Level drops compared to GCSEs within the Redditch districts when comparing with national average. In 2016, only Crabbs Cross, Lodge Park and West wards achieved or exceeded national average points for A-Levels. National averages for 2017 are not available, therefore comparisons cannot be made.

Figure 23: Average Points per entry for A-Level pupils by ward compared to England average

2016 2017 England average 2016

35

30 25

20 Level Level points - 15 10

Average Average A 5 0

Source: Department for Education (Note: Students attending schools in other authorities (e.g. Alcester Grammar) are not included in the Worcestershire figures. Additionally, these figures are for State funded schools only)

57

Redditch Needs and Assets Profile

7.8. Free School Meals

The percentage of primary school pupils known to be eligible for free school meals (FSM) across the districts in Worcestershire is very similar ranging from 13.9% -14.3%, with the national average being 14.1%. However, the percentage for secondary school pupils known to be eligible for FSM is higher than the national average across the majority of the districts. In Redditch, 14.3% of pupils are eligible for FSM compared to the England average of 12.9%.

Figure 23a: Percentage of pupils known to be eligible for free school meals by district in Worcestershire compared to regional and national average - 2017

Primary Schools Secondary Schools England average primary schools England average secondary schools 17

16

15

14

13 Percentage (%) 12

11

10 West Bromsgrove Malvern Hills Redditch Worcester Wyre Forest Wychavon Midlands District

Source: Department for Education

58

Redditch Needs and Assets Profile

7.9. Crime

Figure 24 shows the crime deprivation in Redditch. This indicator measures the rate of recorded crime for four major crime themes – burglary, theft, criminal damage and violence - representing the occurrence of personal and material victimisation at a small area level. This indicator is one of the domains to calculate Indices of Multiple Deprivation scores. The map shows that an area in the South of Abbey Ward, Central Ward and the area bordering Central ward in Batchley and Brockhill are the areas with the worst crime deprivation. This key shows that these areas are within the top 20% of worst crime deprivation areas in England. The darker the shading represents the worst quintile for crime deprivation and the lighter shading represents the best quintile with lower rates of crime deprivation.

Figure 24: Crime deprivation in Redditch

Source: PHE Shape Atlas

Figure 25 shows the hospital admissions for violence, including sexual violence, in Redditch and England. This rate has been significantly lower in Redditch than the national average in recent years. However, the most recent data shows that as the national average has reduced, the Redditch rate is now statistically similar to that in England. This rate is 39.4 per 100,000 population in Redditch compared with 44.8 in England.

59

Redditch Needs and Assets Profile Figure 25: Violent crime (including sexual violence) - hospital admissions for violence; Directly standardised rate - per 100,000

Source: Public Health Outcomes Framework

The rate of violent crime recorded in Redditch has been increasing (Figure 26) and this reflects what is happening nationally. However, these statistics should be interpreted with caution because action taken by police forces to improve their compliance with the National Crime Recording Standard (NCRS) is likely to have resulted in an increase in the number of offences recorded. It is possible, however, that there are other factors which have contributed to the increase.

Figure 26: Violent crime (including sexual violence) - violence offences per 1,000 population; Crude rate - per 100

Source: Public Health Outcomes Framework

60

Redditch Needs and Assets Profile Figure 27 shows the rate of sexual offences in Redditch compared with the rate in England. The inclusion of this indicator enables a focus on the interventions that are effective and evidence-based including a greater focus on prevention and treatment, which need to be considered alongside criminal justice measures for a balanced response to the issue. It is also the government's strategic ambition, as set out in Call to end violence against women and girls 2010 and successive action plans to do what it can to contribute to a cohesive and comprehensive response.

As with the indicator above, the trend of sexual offences in the population is rising both in Redditch and nationally. As stated above, this could be due to changes in the recording of data to comply with the National Crime Recording Standard.

Figure 27: Violent crime (including sexual violence) - rate of sexual offences per 1,000 population, Crude rate - per 1,000

Source: Public Health Outcomes Framework

61

Redditch Needs and Assets Profile 8. Smoking

Smoking is the most important cause of preventable ill health and premature mortality in the UK. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease. It is also associated with cancers in other organs, including lip, mouth, throat, bladder, kidney, stomach, liver and cervix. Smoking is a modifiable lifestyle risk factor; effective tobacco control measures can reduce the prevalence of smoking in the population.

The Government’s Tobacco Control Plan, Towards a Smokefree Generation: A Tobacco Control Plan for England4, published in July 2017 sets out the Government’s strategy to reduce smoking prevalence among adults and young people, and to reduce smoking during pregnancy.

Table 1 reveals the prevalence of smoking in adults in Worcestershire by district. The prevalence is estimated using the Annual Population Survey (APS) and the number of persons aged 18 + who are self-reported smokers. The number of respondents is weighted in order to improve representativeness of the sample. The weights take into account survey design and non-response. Prevalence is highest in Redditch in comparison to other districts in Worcestershire, although it is not statistically significant compared to the England average, when compared to Worcestershire, Redditch has a significantly higher prevalence in comparison to the county average.

Table 1: Smoking prevalence in adults – current smokers in Worcestershire by district and comparison with the English average (15.5%) District Smoking Prevalence (%) Bromsgrove 12 Malvern Hills 12.4 Redditch 19.4 Worcester 15.4 Wychavon 8.5 Wyre Forest 15.6 Worcestershire 13.5 Source: Annual Population Survey 2016 Note: Numbers in orange denote prevalence similar to the national average; numbers in green denote prevalence better than the England average

62

Redditch Needs and Assets Profile

When stratifying smoking prevalence for different occupations, there is a national trend in routine and manual workers that sees the prevalence increase compared to the general population. Although Redditch does not have the highest rates in Worcestershire and it compares with the national average, the data shows there is a 10% increase on the general population prevalence – table 2. This prevalence is not statistically significant compared to the England and Worcestershire average.

Table 2: Smoking prevalence in adults in routine and manual occupations – current smokers in Worcestershire by district and comparison with the English average (26.5%)

District Smoking prevalence in routine and manual occupations (%) Bromsgrove 43.8 Malvern Hills 23.7 Redditch 29.1 Worcester 22.1 Wychavon 17.6 Wyre Forest 41.6 Worcestershire 29 Source: Annual Population Survey 2016 Note: Numbers in orange denote prevalence similar to the national average; numbers in green denote prevalence better than the England average

63

Redditch Needs and Assets Profile 8.1. Smoking and pregnancy

Smoking during pregnancy is known to be harmful to the unborn child. It has well known detrimental effects for the growth and development of the baby and health of the mother. On average, smokers have more complications during pregnancy and labour. These risks include bleeding during pregnancy, placental abruption, premature rupture of membranes, miscarriage, pre-term delivery, low birth weight and infant mortatility5,6. Below are a range of indicators that capture this information for pregnant mothers and their children.

Figure 28 shows the proportion of pregnant women smoking at the time of delivery by district from 2013 – 2016. There has been a general downward trend both nationally and locally. The rate in the West Midlands did increase in 2014/15 however it reduced to just over 13% in 2015/16. Redditch is on a par with the districts with the lowest proportions in Worcestershire, Bromsgrove and Worcester. However, the 95% confidence intervals reveal that the proportion does not statistically differ between the national rates of England, yet it is statistically lower when compared with the West Midlands.

Figure 28: Proportion of pregnant women smoking at time of delivery, by year and district (2013 – 2016), compared to England and the West Midlands 18

16

14

12 England West Midlands 10 Bromsgrove 8 Redditch Worcester 6 Wychavon

4 Wyre Forest Percentage ofpreganant womensomking 2

0 2013/14 2014/15 2015/16 Year

Source: Public Health Outcomes Framework

This indicator for Redditch was previously poor when the last profile was published. The proportion of women smoking at the time of delivery was significantly worse when compared to the national proportions – 16.4% in Redditch compared to 13.3% in England (2011/12 Public Health Outcomes Framework). When comparing this indicator since 2011/12, figure 29 shows that the rate in Redditch has significantly dropped over time, until 2015/16. The proportions in Redditch are now 10.1% compared to 11% in England. Although there is no statistical difference between these two proportions, Redditch has clearly made good improvements in this indicator over the last five years.

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Redditch Needs and Assets Profile Figure 29: Smoking at time of delivery, trend in Redditch and England from 2011 to 2016. 20

18

16

14

12

10 Redditch 8 England

6

4 Proportionofpregnant womensmoking 2

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

Source: Public Health Outcomes Framework

Live births with a recorded birth weight under 2500g and a gestational age of at least 37 complete weeks are defined as low birth weight of a term baby. Figure 30 shows the distribution of low birth weight births in Redditch by wards reported as proportions. Winyates ward has the highest proportion in Redditch (3.7%) which accounts for 18 low birth weight babies in 2016. This is in comparison with Matchborough ward, the lowest proportion in Redditch, 1.5%. This is equivalent to four births in 2016.

65

Redditch Needs and Assets Profile Figure 30: Proportions of Low birth weight of term babies by ward in Redditch (%)

Source: Local health

Figure 31 shows the proportion of mother who breastfeed their babies in the first 48 hours after delivery. Increases in breastfeeding are expected to reduce illness in young children, have health benefits for the infant and the mother and result in cost savings to the NHS through reduced hospital admission for the treatment of infection in infants7. There is evidence that babies who are breast fed experience lower levels of gastro-intestinal and respiratory infection. Observational studies have shown that breastfeeding is associated with lower levels of child obesity. Uptake of breastfeeding in the first 48 hours in Redditch was the second lowest in Worcestershire in 2013/14. This proportion was signinficantly worse compared to England, the West Midlands, Bromsgrove and Worcester. However, the latest data available (2014/15) show good improvements in Redditch. The uptake proportions are now equal to other districts in Worcestershire as well as the West Midlands. This has resulted in an increase from 59.5% to 67.6% uptake in Redditch from 2013 to 2015.

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Redditch Needs and Assets Profile Figure 31: Proportion of all mothers who breastfeed their babies in the first 48hrs after delivery 80

70

60

50

40 2013/14 30 Proportion(%) 2014/15 20

10

0 England West Bromsgrove Redditch Worcester Wyre Forest Midlands Area

Source: Public Health Outcomes Framework (note Malvern data is not available)

Current national and international guidance recommends exclusive breastfeeding for newborns and for the first six months of infancy8,9. Breastfeeding prevalence at 6-8 weeks after birth is thought to be a good indicator of the breastfeeding rates at six-months. In Redditch, prevalence is lower compared to England and other areas in Worcestershire with the exception of Wyre Forest (35.9%). Worcester, Malvern Hills and Bromsgrove prevalence is 51%, 48.9% and 48.4% respectively. The Redditch prevalence rate is significantly lower than each of these rates in Worcestershire, but due to overlapping confidence intervals, this is not the case compared to England.

Figure 32: Breastfeeding prevalence at 6-8 weeks after birth – 2014/15 45 44 43

42 41 40 39

Proportion(%) 38 37 36 35 Redditch England Area

Source: Public Health Outcomes Framework

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Redditch Needs and Assets Profile Figure 33 shows the premature live births, defined as gestational age less than 37 weeks, and still births per 1,000 live and still births by area in 2015/16. The crude rate in Redditch is comparable with other districts in Worcestershire as 95% confidence intervals overlap. This is also the case when comparing rates in England.

Figure 33: Premature live births (gestational age less than 37 weeks) and still births per 1,000 live births and stillbirths by area in 2015/16

140

120

100

80

60

40

20 Crude perrate1,000 live andbirths stillbirths

0 England Redditch Malvern Hills Bromsgrove Worcester Wychavon Wyre Forest Area

Source: Public Health Outcomes Framework

Figure 34 shows these rates as a trend since 2006 until 2015 in Redditch compared to England. Rates in Redditch have been significantly higher than national rates between 2008 and 2011, however these rates have reduced and although the estimated rate is higher, the 95% confidence intervals overlap, therefore we can assume with 95% precision that these rates are not statistically different.

68

Redditch Needs and Assets Profile Figure 34: Premature live births (gestational age less than 37 weeks) and still births per 1,000 live births and stillbirths in Redditch and England from 2006 - 2015 110 105 100

95

90 85 Redditch stillbirths 80 England 75 70

Crude perrate1,000 live andbirths 65 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - 2012 - 2013 - 08 09 10 11 12 13 14 15 Year

Source: Public Health Outcomes Framework

Infant mortality is an indicator of the general health of an entire population. It reflects the relationship between causes of infant mortality and upstream determinants of population health such as economic, social and environmental conditions. Deaths occurring during the first 28 days of life (the neonatal period) in particular, are considered to reflect the health and care of both mother and newborn. Reducing infant mortality overall and the gap between the richest and poorest groups are part of the Government's strategy for public health10

Infant mortality rates in Redditch are similar to the majority of Worcestershire districts with the exception of Worcester who have a significantly higher rate. The rate in Redditch is comparable with the average and there is no statistical difference between the rates. Given the rates and number of incidents are low, this leads to wide confidence intervals as see below.

Figure 35: Infant mortality - Rate of deaths in infants aged under 1 year per 1,000 live births (2014-2016)

10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0

2.0

standardised ofratedeaths - 1.0 3.9 5.5 4.1 4.6 7.1 2.7 5.2 Age 0.0 England Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest District

Source: Public Health Outcomes Framework

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Redditch Needs and Assets Profile 8.2. Smoking related morbidity and mortality

COPD is the fifth biggest killer in the UK and accounts for 5% of all deaths each year. Around 86% of these deaths are caused by smoking, and hence are preventable11. Given the high proportion of these deaths that are due to smoking, a reduction in the prevalence of smoking would reduce the incidence of COPD and extend the life of those with this illness.

Towards a Smokefree Generation: A Tobacco Control Plan for England4 states that tobacco use remains one of our most significant public health challenges and that smoking is the single biggest cause of inequalities in death rates between the richest and poorest in our communities.

As might be expected given the high smoking prevalence, Redditch has the highest rates of mortality from COPD in Worcestershire. This mortality rate is significantly different when compared with Malvern Hills and Wychavon; however it is similar to mortality rates in England.

Figure 36: Age-standardised rate of mortality from chronic obstructive pulmonary disease per 100,000 population by district, 2014-2016 70

60

50

40

30

20

Age Age Standardisedrateper 100,000 10

0 England Bromsgrove Malvern Hills Redditch Worcester Wychavon Wyre Forest District

Source: Office of National Statistics

Figure 37 below reveals the trend mortality rates from COPD in Redditch over recent years. Although rates have not been significantly different to the England average since 2007, from 2013 there has been an observable increase in trend of reported mortality rates in Redditch. The most recent rate being higher than England's.

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Redditch Needs and Assets Profile Figure 37: Age-standardised rate of mortality from chronic obstructive pulmonary disease per 100,000 population in Redditch from 2001 to 2016

Source: Public Health Outcomes Framework

The map below in figure 38 shows that there are two wards that have the highest rate for hospital admissions for COPD. These wards are Greenlands and Batchley & Brookhill; rates of 208.5 and 215.2 per 100,000 population respectively. The lowest rate is West ward with a rate of 69 per 100,000 population.

Figure 38: Emergency hospital admissions for chronic obstructive pulmonary disease, standardised admission ratio 2011/12- 2015/2016

Source: Local Health

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Redditch Needs and Assets Profile Lung cancer is the third most common cancer diagnosed in England. The five-year survival rate for those diagnosed between 2010 and 2014, was 11% for men and 16% for women, which is much lower when compared with Breast and Prostate cancer, the first and second most common cancers diagnosed in England12. Lung cancer is the most common cause of cancer death in the UK, accounting for more than 1 in 5 cancer deaths13.

The link between tobacco and lung cancer was established more than 50 years ago. In England in 2014, 80% of hospital admissions and deaths due to lung cancer in persons aged 35 and over were attributed to smoking14. Lung cancer registration is therefore a direct measure of smoking-related harm. Given the high proportion of these registrations that are due to smoking, a reduction in the prevalence of smoking would reduce the incidence of lung cancer.

Similar to mortality rates from COPD, Redditch has the highest rate of mortality from lung cancer in Worcestershire. This is significantly higher than rates of mortality in Wychavon and Malvern Hills. These districts have the lowest rates of smoking prevalence in Worcestershire. This is statistically similar however, when comparing to England rates.

Figure 39: Age-standardised rate of mortality from lung cancer per 100,000 population, 2014-2016

80

70

60

50

40

30

standardisedrate per 100,000 - 20

10 Directly Directly age

0 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midlands Hills region District / Region

Source: Office of National Statistics

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Redditch Needs and Assets Profile 9. Alcohol

Alcohol is ranked by the World Health Organisation as the third leading cause of death and disability in the developed world15. Around three quarters of Emergency Department attendances at night time and 40% during day time are associated with drinking too much alcohol. Drinking too much also has long-term social consequences such as family break-up, domestic abuse, unemployment, homelessness and financial problems. In Worcestershire 85,000 people drink more alcohol than the recommended limit, which puts their physical and mental wellbeing at risk16.

The reduction of alcohol-related harm is one of the key indicators within Public Health England's national strategy. Alcohol is a significant contributory factor for a range of health conditions and is estimated to cost the NHS approximately £3.5 billion per year and society as a whole £21 billion annually17.

Figure 40 shows the hospital admissions for alcohol-related conditions, all ages by district. These admissions are defined as admissions to hospital where the primary diagnosis or any of the secondary diagnoses are an alcohol-attributable code. Redditch has a higher rate (749 per 100,000) compared to the other five districts in Worcestershire. This is statistically significant as the 95% confidence intervals do not overlap. These confidence intervals overlap with the West Midlands rate which makes them comparable, however when compared to the England average, Redditch's rate is 16% higher. It is 35% higher than Malvern Hills district who have the lowest rate in Worcestershire

Figure 40: Hospital admissions for alcohol-related conditions, all ages by district, England and West Midlands. Directly age standardised rate per 100,000 population, 2015/16 900

800

700

population 600

500 Directly age standardised rateper 100,000

400 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Midlands Hills Forest Region / District

Source: Public Health Outcomes Framework

73

Redditch Needs and Assets Profile

When stratifying this indicator by age, people aged under 40 in Redditch have hospital admission rates of 372 per 100,000. Although it is the highest rate, due to overlapping 95% confidence intervals, this rate is similar when compared with all districts in Worcestershire and the West Midlands with the exception of Worcester. It is higher and statistically significant at the 95% level, when also compared to the national average.

Figure 41: Hospital admissions for alcohol-related conditions, under 40s, directly age standardised rate per 100,000 population - 2015/16

450

400

350

300

250

200

150

Directly Directly standardised age rate per100,000 population 100 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midland Hills Area

Source: Public Health Outcomes Framework

In the over 65s, the rate of hospital admissions for alcohol-related conditions in 3.5 times higher compared to the under 40s in Redditch. This is consistent with national averages, where the incidence rate is 3.2 times higher in comparison. The rate of 1297 per 100,000 is over 100 per 100,000 higher than the next highest rate (Wyre Forest – 1179 per 100,000).Both Malvern Hills and England have rates that are significantly lower than Redditch. Otherwise, compared to the other districts and the West Midlands, Redditch has a similar rate to these areas.

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Redditch Needs and Assets Profile Figure 42: Hospital admissions for alcohol-related conditions, over 65s, directly age standardised rate per 100,000 population - 2015/16 1600

1500

1400

1300

1200

1100

1000

900

800

Directly Directly standardised age rate per100,000 700

600 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midlands Hills Area

Source: Public Health Outcomes Framework

Figure 43 below, shows the hospital admissions for alcohol-related conditions for all ages in Redditch compared to England. Although rates in Redditch where significantly lower than England rates in 2010, the rate in 2015/16 is now significantly higher demonstrating a significant upwards trend in hospital admissions due to alcohol in Redditch.

The rate of hospital admissions for alcohol related harm in Redditch has been increasing and has been significantly higher than England for the last two years. The latest data shows that the rate is 750 admissions per 100,000 compared to the England rate of 647 admissions per 100,000 – figure 43. Rates of admissions for males are not significantly higher compared to the England average. The rate of admissions for females is significantly higher than the England average and has been for the last two years – figure 44.

Figure 43: Hospital admissions for alcohol-related conditions, all ages for Redditch and England, 2008/09 – 2015/16. Directly age standardised rate per 100,000 population

75

Redditch Needs and Assets Profile

850

800

750

700

650 Redditch

600 100,000 England 550

500

Directly age standardised rate per per rate standardised age Directly 450

400 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Year Source: Public Health Outcomes Framework

Figure 44: Hospital admissions for alcohol-related harm in Redditch for Females by year from 2008 to 2016, per 100,000 population

Source: Public Health Outcomes Framework

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Redditch Needs and Assets Profile In the 2013 profile, under 18s alcohol related habits were worse compared to national averages. Figure 45 below demonstrates the significant improvements in the directly standardised rates in comparison to England. The under 18 rates are now classified as similar when compared with national averages due to overlapping confidence intervals.

Figure 45: Hospital admissions for alcohol-related conditions, under 18 for Redditch and England, 2006/07 – 2015/16. Directly age standardised rate per 100,000 population

180 160 140 120 100 80 Redditch 60 England 40 20 0 Directly age standardised rate per 100,000 per rate standardised age Directly 2006/07 - 2007/08 - 2008/09 - 2009/10 - 2010/11 - 2011/12 - 2012/13 - 2013/14 - 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 Year

Source: Public Health Outcomes Framework

Mental health problems are common among those needing treatment for alcohol misuse and alcohol misuse is common among those with a mental health problem. The below indicator shows admissions to hospital where the primary diagnosis is an alcohol-attributable mental and behavioural disorders due to use of alcohol code. Within Worcestershire, the districts in the south of the county have low rates. However, in the north of the county Redditch and Bromsgrove (Wychavon is not reported) have significantly higher rates compared to the south. This could be due to data coding within the main hospitals in each parts of the county. Both Redditch and Bromsgrove rates are comparable to national and regional average rates.

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Redditch Needs and Assets Profile Figure 46: Hospital admissions for mental and behavioural disorders due to use of alcohol condition, all ages, directly age standardised rate per 100,000 population – 2015 / 16

140

120

100

80

60

40

20 Directly Directly standardised age rate per100,000 0 England West Bromsgrove Redditch Worcester Wychavon Wyre Forest Midlands Area

Source: Public Health Outcomes Framework

Coronary heart disease (CHD) is the single most common cause of premature death in the UK. The research evidence relating to the management of CHD is well established and if implemented can reduce the risk of death from CHD and improve the quality of life for patients. Admissions to hospital where the primary diagnosis or any of the secondary diagnoses are an alcohol-attributable cardiovascular disease code. Children aged less than 16 years were only included for alcohol-specific conditions and for low birth weight. These rates are presented in figure 47. The Redditch rate (1,230 per 100,000) is significantly higher than the England rate (1,107 per 100,000) in additional to all other districts in Worcestershire. This is 48% higher than the lowest rate in Malvern Hills, 829 per 100,000 population.

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Figure 47: Hospital admissions for alcohol-related cardiovascular disease conditions, all ages by district, directly age standardised rate per 100,000 population – 2015 / 16

1400

1200

1000

800

600

400

200 Directly age standardised rateper 100,000

0 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midlands Hills Area

Source: Public Health Outcomes Framework

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Redditch Needs and Assets Profile 10. Physical Activity

The last health profile for Redditch in 2013 identified that physical activity participation and uptake was lower compared to other districts in Worcestershire with the exception of Worcester. Consequently, the estimated percentage of obese adults was highest in Redditch. This was significantly worse than the national average. Within Redditch, the highest levels of obese adults were situated in the North of the district. Figure 48 shows the spine chart for physical activity and related conditions in Redditch.

Figure 48: Physical activity spine chart, key indicators and related conditions for Redditch

Source: Public Health Outcomes Framework

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Redditch Needs and Assets Profile The modelled estimates of participation referred to below are based on data from Sport England’s Active Lives survey. This survey has superseded the Active People Survey which has been discontinued. The methodology for determining physical activity levels has changed therefore previous indicators cannot be compared. The survey measures participation in sport and active recreation at regional level, (214,000 took part in the survey in 2016/17). Participation estimates at a Middle Super Output area (MSOA) are therefore based on modelled or ‘synthetic’ estimates which combine survey data from the Active Lives Survey with area level data (for example, health indicators, socioeconomic status etc).

All districts in Worcestershire have physical activity levels higher than the West Midlands. Both Malvern Hills and Wyre Forest levels of physically active adults are statistically higher for England and the West Midlands. Redditch has average levels of physically active adults compared to England as the 95% confidence intervals overlap with the national average and range. This is shown in figure 49 below.

Figure 49: Percentage of physically active adults (19+) by area in 2015/16 80

75

70

65 Proportion(%) 60

55

50 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midlands Hills region Area

Source: Public Health England (based on Active Lives, Sport England)

As might be expected given the previous figure, Malvern Hills and Wyre Forest have the lowest levels on physically inactive adults in Worcestershire (figure 50). However, this is not a statistical significant level as the 95% confidence intervals overlap with the national confidence interval range. Along with Bromsgrove, Redditch has the highest levels of physically inactive adults in Worcestershire at 23.5%. However, confidence intervals overlap therefore this is not statistically different to elsewhere in Worcestershire, the West Midlands and nationally.

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Redditch Needs and Assets Profile Figure 50: Percentage of physically inactive adults (19+) by area in 2015/16 30

25

20

15

Proportion(%) 10

5

0 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midlands Hills Area

Source: Public Health England (based on Active Lives, Sport England)

Walking is the most likely way all adults can achieve the recommended levels of physical activity18 and walking for at least 10 minutes at least five days a week suggests regular walking. Figure 51 shows the percentages that do any walking, at least five times per week, by area in 2015/16. There is a 7% difference between the district with the highest percentage, Wychavon, and the district with the lowest percentage, Wyre Forest. The proportions in Redditch are towards the lower range. However, confidence intervals for each area overlap therefore there are no significant differences between the areas, both locally and nationally.

Figure 51: Percentage of adults who do any walking, at least five times per week, by area in 2014/15 60

55

50

45

Percentage (%) 40

35

30 England West Bromsgrove Malvern Redditch Worcester Wychavon Wyre Forest Midlands Hills Area

Source: Department for Transport; Active People Survey, Sport England

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Redditch Needs and Assets Profile Walking for less than 10 minutes at least once a week suggests a low activity level and allows further insight into areas where active travel is potentially less prevalent. When comparing this across Worcestershire, as with adults walking for at least 10 minutes at least five days a week, the variation is similar. Worcester has the highest percentage, 83%, giving them the lowest number of adults with a low level of activity – 17%. Redditch has a percentage of 78%, meaning that 22% of adults walk less than 10 minutes per week – figure 52. Confidence intervals for each area overlap therefore there are no significant differences between the areas. Due consideration should be given to the active travel availability across the different districts, with Worcester potentially provding the best availability given the transport and urban infrastructure.

Figure 52: Percentage of adults who do any walking, at least once per week, by area in 2015/16 90

85

80

75 Percentage (%)

70

65

Area

Source: Department for Transport; Active People Survey, Sport England

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Redditch Needs and Assets Profile Redditch continues to have high levels of overweight or obese adults aged 18 or over. At 67.7%, it is the highest percentage of adults classified as overweight or obese in Worcestershire. Confidence intervals show that the higher percentage is statistically significant when compared to national percentages. It is known that adults tend to underestimate their weight and overestimate their height when providing self-reported measurements and the extent to which this occurs can differ between population groups. Therefore prevalence of excess weight (overweight including obese) calculated from self- reported data is likely to produce lower estimates than prevalence calculated from measured data.

Figure 53: Percentage of adults (aged 18+) classified as overweight or obese, by area – 2015 / 16 75

70

65

60

55 Proportion(%) 50

45

40

Area

Source: Public Health England (based on Active Lives survey, Sport England)

The UK is experiencing an epidemic of obesity affecting both adults and children. The Health Survey for England (HSE) found that among boys and girls aged 2 to 15, the proportion of children who were classified as obese increased from 11.7 per cent in 1995 to 16.0 per cent in 2010, peaking at 18.9 per cent in 2004.

There is concern about the rise of childhood obesity and the implications of such obesity persisting into adulthood. The risk of obesity in adulthood and risk of future obesity-related ill health are greater as children get older. Studies tracking child obesity into adulthood have found that the probability of overweight and obese children becoming overweight or obese adults increases with age19–21.

Figure 54 shows the prevalence of overweight and obese children in both Reception and Year 6 by district in 2016/17. For Reception children measurements, Redditch is higher than national average at 24.8%. Although this is not statistically different from national data, it is

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Redditch Needs and Assets Profile very close to being so. Additionally, there is no statistical significance when comparing children in reception across Worcestershire or the West Midlands.

For children in year 6, Bromsgrove district has significantly lower prevalence rates of overweight or obese children when compared to Redditch, Wychavon and Wyre Forest. Redditch has a prevalence of 35.1% which is on average with national and regional data, but the joint second highest prevalence in Worcestershire after Malvern Hills.

From reception to year six, there is a 40% increase in the prevalence of children who are overweight and obese in Redditch. This equates to 1 in 4 children overweight or obese children in reception to 1 in 3 by year 6. This is comparable to national and regional data.

Figure 54: Prevalence (%) of overweight (including obese) children in Reception and Year 6 by district in 2016/17 45

40

35

30

25

20

Prevalence(%) 15 Reception

10 Year 6

5

0

Area

Source: NHS Digital, National Child Measurement Programme

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Redditch Needs and Assets Profile The two figures below show the trend of overweight and obese children in Reception and year 6 in Redditch between 2006 and 2016. Reception prevalence (figure 55) in Redditch has hovered around the national average in England over the last 10 years with two peaks that revealed statistically significant differences between Redditch and England (Redditch prevalence being higher). These peaks occurred in 2006/7 and 2013/14.

Figure 55: Prevalence (%) of overweight (including obese) children in Reception between 2006/7 – 2015/16 in Redditch

Source: NHS Digital, National Child Measurement Programme

The prevalence of overweight and obese children in year 6 has been increasing nationally since 2006/7 as seen in figure 56. Redditch prevalence in this time has been largely similar to the England average with a peak significantly higher than national average in 2010/11.

Although prevalence for overweight and obese children in Redditch is currently similar to national average, due consideration should be given to the link between deprivation and obesity. Across Worcestershire, the prevalence of children who are overweight or obese is higher in more deprived areas in reception and year 6 – figure 56a and 56b respectively. It is not possible to replicate this analysis at a Council District level due to the small numbers involved. However, this should be considered relevant to Redditch given the levels of deprivation within the district.

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Redditch Needs and Assets Profile Figure 56: Prevalence (%) of overweight (including obese) children in Year 6 between 2006/7 – 2015/16 in Redditch

Source: NHS Digital, National Child Measurement Programme

In 2016/17, there were 26.5% reception children classed as having excess weight living in the most deprived quintile of Worcestershire. This compares with just 19.3% in the least deprived quintile. This is over 7 percentage points difference between children living in the most and least deprived areas of Worcestershire – figure 56a.

Figure 56a: Reception Year – percentage overweight or obese by deprivation quintile in 2016/17 Reception Year - Percentage Overweight or Obese by Deprivation Quintile in 2016/17 35.0%

30.0%

25.0%

20.0%

15.0%

10.0%

5.0%

0.0% 1 - Most deprived 2 3 4 5 - Least deprived

Source: NHS Digital, National Child Measurement Programme

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Redditch Needs and Assets Profile In 2016/17, there were 39.3% year 6 children classed as having excess weight living in the most deprived quintile of Worcestershire. This compares with just 29.8% in the least deprived quintile. This is 9.5 percentage points difference between children living in the most and least deprived areas of Worcestershire.

Figure 56b: Year 6 – percentage overweight or obese by deprivation quintile in 2016/17

Source: NHS Digital, National Child Measurement Programme

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Redditch Needs and Assets Profile 11. Mental Health

Due to challenges with mental health service access and service outcomes in recent years, Mental Health services in Redditch underwent a redesign in 2016. This has predominantly led to the introduction of the healthy minds service, a wellbeing hub and increased capacity within GP services and primary care. Due to the redesign taking place recently, the data presented in this section may not reflect the increase in capacity of services and therefore improve access. It is hoped that this influences outcomes and improves mental health in Redditch.

There is emerging evidence on the importance of psychosocial risk factors throughout life such as loneliness, isolation and depression. These factors may reduce resilience to disease onset and progression. Psychosocial factors may be as important as physical factors in reducing the risk of dementia, but more evidence is needed.

Depression is responsible for 12% of the global burden of non-fatal disease and is expected to be the world's second most disabling disease by 2020 (after cardiovascular disease). It is also responsible for 109 million lost working days every year in England at a cost of £9billion.

11.1. Prevalence and Incidence

The recorded depression prevalence is the number of people with depression recorded on their practice register within a CCG, as a proportion of the practice list size of the CCG aged 18 years or over. Redditch and Bromsgrove CCG have a significantly higher rate of depression prevalence compared with England. In 2011/12 the prevalence rate was higher in both England and Redditch however; there was a drop in prevalence in 2012/13 by close to 10%. This might be explained by a change in the coding of the data or a change in the definition of depression and how it was recorded by QOF. Since 2012/13, prevalence has been increasing both locally and nationally. This could be explained by a reduction in the stigma related to mental health that has been undertaken nationally over recent years, therefore increasing the number of presenting cases and therefore prevalence in the community.

Figure 57: Depression recorded prevalence (QOF): % of practice register aged 18+; NHS Redditch and Bromsgrove compared with England, 2015/16

Source: Quality Outcomes Framework

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When comparing depression prevalence across CCGs, Redditch and Bromsgrove CCG lies between Wyre Forest CCG and South Worcestershire CCG. Wyre Forest has the highest recorded prevalence (14.1%) and South Worcestershire CCG has the lowest prevalence in Worcestershire (8.5%).

Figure 58: Depression recorded prevalence (QOF): % of practice register aged 18+; comparison of CCGs in Worcestershire and England average, 2015/16 16

14

12

10

8

6 Prevalence(%)

4

2

0 England NHS Wyre Forest CCG NHS Redditch and NHS South Bromsgrove CCG Worcestershire CCG Area

Source: Quality Outcomes Framework

Depressions incidence equates to the number of new cases of depression diagnosed in an area over a given period of time. The incidence of depression in Redditch is significantly higher than the England national average. In 2012/13, this was significantly lower than the England average; however it has significantly increased to surpass the England average, shown in figure 59. As stated above, this could be explained by a reduction in the stigma related to mental health, therefore increasing the number of presenting cases and consequently incidence in the community.

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Figure 59: Depression recorded incidence (QOF): % of practice register aged 18+; NHS Redditch and Bromsgrove compared with England, 2015/16

Source: Quality Outcomes Framework

11.2. Self-Harm indicators

Self-harm is one of the top five causes of acute medical admission and those who self-harm have a 1 in 6 chance of repeat attendance at Accident and Emergency within the year. One study of people presenting at Accident and Emergency (A&E) showed a subsequent suicide rate of 0.7% in the first year – 66 times the suicide rate in the general population17. Hospital admissions for self-harm in children have increased in recent years, with admissions for young women being much higher than admissions for young men. With links to other mental health conditions such as depression, the emotional causes of self-harm may require psychological assessment and treatment.

Self-harm is an expression of personal distress and there are varied reasons for a person to harm themselves irrespective of the purpose of the act. There is a significant and persistent risk of future suicide following an episode of self-harm. Self-harm events severe enough to warrant hospital admission. These hospital admissions are being used as a proxy of the prevalence of severe self-harm; these are only the tip of the iceberg in relation to the health and well-being burden of self-harm.

Figure 60 shows the rate of emergency hospital admissions for intentional self-harm in Redditch is significantly higher at 278.1 admissions per 100,000 compared to 208.9 admissions per 100,000 in the West Midlands and 196.5 admissions per 100,000 for England overall. Redditch has the second highest rate of admissions across the West Midlands region. Rates are significantly higher for females (341.7) in comparison to males (218.3).

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Redditch Needs and Assets Profile Figure 60: Emergency Hospital Admissions for Intentional Self-Harm in Redditch in comparison to England (hospital admissions per 100,000)

Source: Public Health Outcomes Framework

Some caution is urged when interpreting data on self-harm trends from Hospital Episode Statistics (HES) data. Large increases could be due to improved data collection. However, it is important to monitor the trend over time to see whether this trend is likely to continue.

Figure 61 shows this data by gender and by district in Worcestershire. Both male and female self-harm rates in Redditch are significantly higher compared to national and regional rates. This is also the case for male rates compared to Malvern Hills and Wyre Forest, and female rates when compared to all other Worcestershire districts apart from Wyre Forest. In line with national data, self-harm rates are higher in females than males in Redditch. Figure 62 demonstrates that this trend has been consistent in Redditch over the last 7 years. This picture is not reflected across all districts in Worcestershire where in Bromsgrove, male rates are higher than female rates.

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Redditch Needs and Assets Profile Figure 61: Emergency Hospital Admissions for Intentional Self-Harm, all ages by area and gender, directly age standardised rate per 100,000 population – 2015 / 16

450

400

350

300

250

200 Male 150 Female 100

50 Directly Directly standardised age rate per100,000 0

Area

Source: Public Health Outcomes Framework

Figure 62: Emergency Hospital Admissions for Intentional Self-Harm, all ages by year and gender in Redditch, directly age standardised rate per 100,000 population – 2015 / 16

450

400

350

300

250

200 Female Male 150

100

50 Directly standardisedDirectly age 100,000 perrate 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Year

Source: Public Health Outcomes Framework

Table 3 below shows the self-harm data for children and young people aged from 10-24. This represents hospital admissions due to self-harm by CCG in 2014/15. Redditch and

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Redditch Needs and Assets Profile Bromsgrove CCG have a significantly higher rate than most CCGs in the West Midlands and all other CCGs in Worcestershire. As set out above, some caution is urged due to the improvements in data collection regarding self-harm. However, this should be monitored over time.

Table 3: Hospital admissions as a result of self-harm: DSR per 100,000 population aged 10-24 by CCG in the West Midlands; 2014/15

11.3. Access to Mental Health services

The below figure 63, reveals the crude rate per 100,000 population aged over 18 entering IAPT treatment in Redditch in comparison to England. The rate in Redditch was significantly lower than that of England's as of April 2017. This trend has been consistent since 2013.

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Figure 63: Entering IAPT treatment: crude rate per 100,000 population aged 18+; NHS Redditch and Bromsgrove compared to England to 2016/17

Source: Public Health Outcomes Framework

Figure 64 reveals access to IAPT services information based on patients that are diagnosed with anxiety or depression. Most recently, since April 2017 until June 2017, the data shows an improvement of access into the IAPT services for those specific patients. This data is positive as it potentially reflects the recent changes made to mental health services in the district. Sustained improvements in the data and access to the service have not been seen over the last four years and it would suggest that the appropriate patients and individuals are accessing the IAPT services.

Figure 64: Access to IAPT services: people entering IAPT (in month) as % of those estimated to have anxiety/depression to 2016/17; NHS Redditch and Bromsgrove CCG compared to England

Source: Public Health Outcomes Framework

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As the changes to mental health services are fairly recent, data regarding completion of treatment does not reflect the improvements to access. However, within Redditch and Bromsgrove CCG boundaries, this is on an upwards trend more recently since April 2016.

Figure 65: Completion of IAPT treatment: rate (quarterly) per 100,000 population aged 18+; NHS Redditch and Bromsgrove CCG compared to England 2013 - 2017

Source: Public Health Outcomes Framework

Children and young people aged under 18 in Child and adolescent mental health services (CAMHS)

Data on usage of tier 4 CAMHS beds is shown below. This indicates that for usage of bed days for CAMHS tier 4 wards is significantly lower than England average in Redditch. The rate of admissions for CAMHS tier 4 wards in Redditch is around average as seen in table 4.

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Table 4: Rate of bed days for children and young people aged under 18 in CAMHS (2015/16) Clinical Commissioning Rate per 10,000 under 18 Significance Group population England 275.3 - South Worcestershire 318.9 Significantly higher than England average Redditch and Bromsgrove 206.4 Significantly lower than England average Wyre Forest 267.6 Around England average Source: NHS Rightcare 2015/16

Table 5: Rate of admissions for children and young people aged under 18 in CAMHS tier 4 wards (2015/16) Clinical Commissioning Rate per 10,000 under 18 Significance Group population England 11.7 South Worcestershire 11.7 Around England average Redditch and Bromsgrove 8.3 Around England average Wyre Forest 10.7 Around England average Source: NHS Rightcare 2015/16

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Redditch Needs and Assets Profile 12. Other Areas of Concern and Changing Needs

12.1. Hospital admissions caused by unintentional and deliberate injuries in children

Injuries are a leading cause of premature mortality and hospitalisation for children. In Redditch, the rate of hospital admissions caused by unintentional and deliberate injuries in children and young people is significantly higher than both the West Midlands and England average across all age groups (0-4 years, 0-14 years and 15-24 years).

In Redditch, 2015/16, the rate of hospital admissions caused by unintentional and deliberate injuries in children aged 0-4 years was significantly higher than both the West Midlands and England rates at 191.7 hospital admissions per 10,000. This is also the same for children aged 0-14 where rates were 145.4 hospital admissions per 10,000 in 2015/16, compared to 125.2 in 2014/15 – see figure 66 below

Figure 66: Hospital admissions caused by unintentional and deliberate injuries in children in Redditch, West Midlands and England (2015-16)

Source: Public Health Outcomes Framework

This is the first year that rates have been significantly higher and have increased sharply from 2014/15 when the rate was 137.5 per 10,000 for children aged 0-4 years – see figure 67a. This is replicated in the data for children aged 0-14 years – see figure 67b. The rate is also the second highest across the West Midlands region, second only to Coventry. This will require monitoring at a local level to see if this is a trend. It is important to consider that whilst Hospital Episode Statistics (HES) data is considered to be generally robust, it can be sensitive to changes in coding practices at trust level.

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Figure 67a: Hospital admissions caused by unintentional and deliberate injuries in children aged 0-4 years in Redditch compared to England; trend from 2010 - 2016

Source: Public Health Outcomes Framework

Figure 67b: Hospital admissions caused by unintentional and deliberate injuries in children aged 0-14 years in Redditch compared to England; trend from 2010 - 2016

Source: Public Health Outcomes Framework

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12.2. Recorded Diabetes

The proportion of recorded diabetes in Redditch is significantly higher at 7.0% compared to the England average at 6.4%. It is the highest recorded rate across the Worcestershire districts. National data shows more deprived areas have a higher proportion of people with recorded diabetes than less deprived areas with a proportion of recorded diabetes of 7.2% in the most deprived areas compared to 5.1% in the least deprived areas.

Figure 68: Recorded diabetes; Redditch compared to England 2010-2015

Source: Public Health Outcomes Framework

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12.3. Influenza Vaccination

Vaccination against flu is an important public health intervention. Flu can be a dangerous disease, particularly for the very young and the older population. There are also other at-risk groups such as pregnant women and immunocompromised individuals. Vaccination against flu can reduce pressures on health services by reducing hospital admissions and limit exacerbations of existing medical conditions in these particular groups. The target level for vaccination uptake during 2016-17 was 75.0% for individuals aged 65 and over and 55.0% for individuals considered being at-risk aged 18+.

Redditch and Bromsgrove CCG fell short of the target at 71.0% of individuals aged 65 and over were vaccinated; this was the lowest across the three CCG groups in Worcestershire. 50.5% of individuals in at-risk groups were vaccinated against a target of 55.0%.

12.4. Chlamydia Detection Rate 15-24yr olds

The National Chlamydia Screening Programme (NCSP) recommends screening for all sexually active young people under 25 annually or on change of partner (whichever is more frequent). The chlamydia detection rate amongst under 25 year olds is a measure of chlamydia control activity, aimed at reducing the incidence of reproductive sequelae of chlamydia infection and interrupting transmission onto others Public Health England (PHE) recommends that local authorities should be working towards achieving a detection rate of at least 2,300 per 100,000 population aged 15-24. The recommendation was set as a level that would encourage high volume screening and diagnoses17. The chlamydia detection rate in Redditch was significantly higher in 2015 but in 2016 the rate was similar to the national average at 2,000 per 100,000 population aged 15-24 compared to the England rate at 1,882 per 100,000 population aged 15-24.

Figure 69: Chlamydia detection rates in 15-24 year olds in Redditch compared to England, per 100,000 population

Source: Public Health Outcomes Framework

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13. References

1. Cooper R, Boyko C, Codinhoto R. Mental Capital and Wellbeing: Making the most of ourselves in the 21st century. Foresight. 2008:1-22. doi:10.1186/1748-5908-8-17.

2. NHS England. Five Year Forward View. 2014;(October) https://www.england.nhs.uk/wp- content/uploads/2014/10/5yfv-web.pdf.

3. Nesta. We change the world - What can we learn from global social movements for health? 2017;(November). https://www.nesta.org.uk/sites/default/files/we_change_the_world.pdf.

4. Department of Health. Towards a Smokefree Generation: A Tobacco Control Plan for England. 2017;(July).

5. Anblagan D, Jones NW, Costigan C, et al. Maternal Smoking during Pregnancy and Fetal Organ Growth: A Magnetic Resonance Imaging Study. PLoS One. 2013;8(7):1-7. doi:10.1371/journal.pone.0067223.

6. Pineles BL, Park E, Samet JM. Systematic Review and Meta-Analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy. Am J Epidemiol. 2014; 179(7): 807-823. doi:10.1093/aje/kwt334.

7. Quigley MA, Kelly YJ, Sacker A. Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study. Pediatrics. 2007;119(4):e837-e842. doi:10.1542/peds.2006-2256.

8. WHO. Infant and young child nutrition: Global strategy on infant and young child feeding. Fifty Fifth World Heal Assem. 2002;53(April):1-18. http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf.

9. NICE. Maternal and child nutrition. 2008;(March). doi:10.1016/S0140-6736(13)62319-3.

10. Hm Government. Healthy Lives , Healthy People :Our Strategy for Public Health in England. Vol 363.; 2010. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuid ance/DH_121941.

11. Public Health England. Public Health Outcomes Framework: Local Tobacco Control Profile. Public Health Outcomes Framework: Local Tobacco Control Profile. https://fingertips.phe.org.uk/search/COPD#page/3/gid/1/pat/6/par/E12000005/ati/101/are/E 07000236/iid/1204/age/1/sex/4.

12. ONS. Cancer survival in England: Patients diagnosed between 2010 and 2014 and followed up to 2015. May 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsan ddiseases/bulletins/cancersurvivalinenglandadultsdiagnosed/2010and2014andfollowedupt o2015.

13. ONS. Death registrations summary tables - England and Wales. July 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/ datasets/deathregistrationssummarytablesenglandandwalesreferencetables.

14. NHS Digital. Statistics on smoking, England. 2016.

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http://digital.nhs.uk/catalogue/PUB20781.

15. WHO. Global status report on alcohol and health. World Heal Organ. 2014:1-100. doi:/entity/substance_abuse/publications/global_alcohol_report/en/index.html.

16. Worcestershire County Council. Worcestershire Joint Health and Wellbeing Strategy 2016 to 2021.; 2016.

17. Public Health England. Public Health Outcomes Framework – Healthcare and premature mortality indicator. 2016 http://www.phoutcomes.info/public-health-outcomes- framework#page/0/gid/1000044/pat/6/par/E12000004/ati/102/are/E06000015.

18. NICE. Physical Activity: Walking and Cycling. Clinical Guideline; 2012.

19. Guo, Chumlea. Tracking of body mass index in children in relation to overweight in adulthood. Am J Clin Nutr. 1999;70(1 Part 2):145S-148S.

20. Starc G, Strel J. Tracking excess weight and obesity from childhood to young adulthood: a 12-year prospective cohort study in Slovenia. Public Health Nutr. 2011;14(1):49-55. doi:10.1017/S1368980010000741.

21. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med (Baltim). 1993;22(2):167-177. doi:10.1006/pmed.1993.1014.

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Redditch Needs and Assets Profile 14. Appendix

14.1. Appendix One

Population variables for Redditch including births, deaths and migration figures

Values Estimated Population 2016 84,971 Births 1,101 Deaths 679 Births minus Deaths 422 Internal Migration Inflow 2600 Internal Migration Outflow 3181 Internal Migration Net -581 International Migration Inflow 607 International Migration Outflow 233 International Migration Net 374 Other 13 Estimated Population 2015 84,743 Population Change 228 % Population Change 0.27% % Population Change due to Births and Deaths 0.50% % Population Change due to Internal Migration -0.69% % Population Change due to International Migration 0.44% % Population Change due to Other Adjustments 0.02% Source: ONS Mid-year population estimates 2016

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