Joint Strategic Needs Assessment 2013 - 2014 Contents 1 Introduction ....................................................................................................... 1 1.1 Introduction to the Joint Strategic Needs Assessment .................................. 1 1.2 What does this report contain? ...................................................................... 1 1.3 Core indicators .............................................................................................. 2 1.4 Additional CCG local commissioning priorities .............................................. 6 1.5 Related South Tyneside strategies ............................................................... 6 1.5.1 Our Better Health and Wellbeing Strategy 2013/14 ..................................... 6 1.6 Evidence and the JSNA ................................................................................ 8 1.6.1 Introduction .................................................................................................... 8 The evidence base generally and the NICE guidance in particular, enables the JSNA recommendations for commissioned services to be in line with the best available evidence of clinical and cost-effectiveness, enabling local people to be assured that local programmes will be provided using a consistent evidence-based approach, to not only provide a basis to support local people to improve their own health and prevent disease but also to effectively target resources and efforts at the areas that offer the most significant health improvement. ........................................................... 8 1.6.2 Examples of the use of Evidence base ........................................................ 8 1.6.2.1 Best Start in Life .................................................................................................... 8 1.6.2.2 Across the Lifecourse........................................................................................... 9 1.6.2.3 Commissioning and integrated services .......................................................... 10 1.6.3 Recommendation ........................................................................................... 10 2 Progress on previous JSNA ........................................................................... 11 2.1 Every child to have a good start in life ......................................................... 11 2.2 Increased life expectancy with reduced differences between communities 14 2.3 Better employment prospects for young people .......................................... 17 2.4 Better mental health and emotional well-being for older people .................. 18 2.5 Better quality, integration and efficiency of services .................................... 19 3 Core priority indicator data ............................................................................ 21 3.1 Health outcomes ......................................................................................... 21 3.1.1 Births and general fertility rates ................................................................. 21 3.1.2 Projected numbers of births ....................................................................... 21 3.1.3 Infant mortality rate ..................................................................................... 21 3.1.4 Premature mortality rate due to circulatory disease ................................. 22 3.1.5 Core priority indicators presented elsewhere in this report. .................... 23 3.2 Health-related behaviour ............................................................................. 23 3.2.1 Teenage conception rates.............................................................................. 23 3.2.2 Breastfeeding – continuation ...................................................................... 24 3.2.3 Obesity among primary school age children in Reception Year .............. 27 3.2.4 Obesity among primary school age children in Year 6 ............................. 27 3.2.5 Core priority indicators presented elsewhere in this report. .................... 28 3.3 Determinants of health ................................................................................ 28 3.3.1 Rates of homeless households .................................................................. 28 3.3.2 Core priority indicators presented elsewhere in this report ..................... 29 3.4 Service uptake and diagnosis rates ............................................................ 29 3.4.1 MMR vaccination ......................................................................................... 29 3.4.2 Hypertension, diagnosed vs expected prevalence .................................... 31 3.4.3 Chlamydia diagnoses (crude rate per 100,000 aged 15-24 years) ............ 31 4 Health and well-being strategy: (i) the best start in life: “Safeguarding Children” ............................................................................................................... 32 4.1 Introduction ................................................................................................. 32 4.2 South Tyneside’s service model .................................................................. 32 4.3 Understanding need in South Tyneside ...................................................... 38 4.3.1 Tier 1 - Universal .......................................................................................... 38 4.3.1.1 Disability .............................................................................................................. 38 4.3.1.2 Engagement with universal services ................................................................ 39 4.3.1.3 Information from Child Death Review ............................................................... 40 4.3.2 Tier 2 - targeted early help .......................................................................... 40 4.3.2.1 Early Help Processes (formerly referred to as Common Assessment)......... 40 4.3.2.2 High Impact Families .......................................................................................... 40 4.3.2.3 Children’s Centres .............................................................................................. 41 4.3.3 Young Carers ............................................................................................... 42 4.3.4 Tiers 3 & 4 Children in need, child protection and looked after children . 42 4.4 Children with disabilities in receipt of specialist services ............................. 44 4.5 Child protection & safeguarding .................................................................. 45 4.5.1 Child protection plans by category ............................................................ 45 4.5.2 Child Protection Plans ceasing - step up or down .................................... 46 4.5.3 Sexual exploitation. ..................................................................................... 48 4.5.4 Missing Children Data .................................................................................. 49 4.5.5 Healthy Schools ........................................................................................... 51 4.6 Looked After Children ................................................................................. 51 4.6.1 LAC Health ................................................................................................... 51 4.6.2 Access to CAMHs Tier 3 .............................................................................. 52 Work remains ongoing with the provider to drive down waiting times through the specifically commissioned waiting time initiatives and to embed a menu of services across the tiers of need in respect of emotional well being and mental health. ........ 53 4.6.3 Children involved in the Youth Justice system ......................................... 53 4.7 The causes of safeguarding concerns ........................................................ 53 4.7.1 Child poverty ................................................................................................ 54 4.8 Toxic trio ..................................................................................................... 54 4.8.1 Substance misuse ....................................................................................... 54 4.8.1.1 Alcohol Prevalence ............................................................................................. 56 4.8.2 Mental health factors ................................................................................... 57 4.8.3 Domestic abuse ........................................................................................... 57 4.9 Identifying our priorities ............................................................................... 60 4.10 Recommendations ...................................................................................... 62 1. To continue to work with partner agencies to embed early approaches to reduce demand upon specialist and acute services .............................................. 62 5 Health and well-being strategy: (ii) increased healthy life expectancy with reduced differences between communities – .................................................... 63 “A focus on cancer” ............................................................................................ 63 5.1 Introduction to cancer .................................................................................. 63 5.2 Cancer and early mortality in South Tyneside ............................................