Children and Young People Summary
Transcription
Children and Young People Summary
Cheshire West and Chester Joint Strategic Needs Assessment Cheshire West and Chester Joint Strategic Needs Assessment Children and Young People Summary Updated August 2015 v2 Visit www.cheshirewestandchester.gov.uk/JSNA [email protected] Introduction Cheshire West and Chester Joint Strategic Needs Assessment Joint Strategic Needs Assessment (JSNA) The Cheshire West and Chester Joint Strategic Needs Assessment (JSNA) is a suite of products that supports understanding of the health and wellbeing within the population so that the Council, NHS and other organisations, can work together to improve the quality of life of local people. This summary report looks at available information about multiple factors that impact on the health and wellbeing of children and young people in Cheshire West and Chester. Understanding the needs of local people is essential if we are going to provide and commission suitable services that really make a difference. Some sections in the summary refer to indicators used within the Public Health Outcomes Framework (PHOF) or the NHS Outcomes Framework (NHSOF). These are notated within the title. Detailed data for some of the issues discussed in this summary are available within other ISNA products available online www.cheshirewestandchester.gov.uk/JSNA In particular: • Children’s centre dashboards • Locality dashboards • Census profiles The Children’s JSNA has taken the format of a ‘summary on a page’ to tell a story of a topic. This brings together analysis, evidence and recommendations to help identify and address key issues. It is intended that JSNA products will be updated and refined as new information and intelligence is developed and made available. Work will continue to identify and collate information that helps understand the needs of children and young people in Cheshire West and Chester. Contact: [email protected] Authored collaboratively by partners of the Cheshire West and Chester Children’s Trust and compiled by the Strategic Intelligence Team, part of the Cheshire West and Chester Public Health Team. www.cheshirewestandchester.gov.uk/JSNA Cheshire West and Chester Joint Strategic Needs Assessment Contents Population Summary ………………………………………………………………………………………..………………………………….. Health and wellbeing Children in poverty ……………………………………………………………………………………………….……………… Breastfeeding prevalence ……………………………………………………………………………………….……………… Excess weight in four to five year olds …………………………………………………………………………………….….. Excess weight in 10 to 11 year olds …………………………………………………………………………………………… Hospital admissions caused by unintentional and deliberate injuries in children ………………………………………… Hospital admissions caused by unintentional and deliberate injuries in young people aged 15 to 24 ………………… Emergency admissions for children with lower respiratory tract infections ………………………………………………. Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s ……………………………………………… Sexually transmitted infections (STIs) and young people aged under 25 ………………………………………………… Conceptions in women aged under 18 ……………………………………………………………………………………….. Achievement and wellbeing School readiness ……………………………………………………………………………………………………………….. Narrowing the gap in educational achievement: Key stage two …………………………………………………………… Narrowing the gap in educational achievement: Five GCSEs A* to C or equivalent including English and Maths …. School attendance ……………………………………………………………………………………………………………… Special Educational Needs (SEN) ……………………………………………………………………………………………. Young people not in education, employment or training (NEET) ……………………………………………………….…. Early Support Children’s centres ………………………………………………………………………………………………………………. Team around the family ……………………………………………………………………………………………………….. Children and families complex cases (level three) …………………………………………………………………………. Troubled families ……………………………………………………………………………………………………………….. Children with acute needs (level four) Children in need ………………………………………………………………………………………………………………… Children on Child Protection Plans …………………………………………………………………………………………… Children in care …… …………………………………………………………………………………………………………… Children in care: Demand ……………………………………………………………………………………………………… Children in care: Placements ………………………………………………………………………………………………….. Health needs of children in care ………………………………………………………………………………………………. Adoption …………………………………………………………………………………………………………………………. Domestic abuse affecting children and young people ……………………………………………………………………… Young people age 13 to 19 years healthy relationships and disclosure of domestic abuse …………………….…….. Child sexual exploitation ………………………………………………………………………………………………………. Young people’s issues ………………………………………………………………………………………………………………………… Visit www.cheshirewestandchester.gov.uk/JSNA or contact Strategic Intelligence [email protected] page 1 page 3 page 4 page 5 page 6 page 7 page 8 page 9 page 10 page 11 page 12 page 13 page 14 page 15 page 16 page 17 page 19 page 20 page 22 page 23 page 24 page 25 page 26 page 27 page 28 page 29 page 30 page 31 page 32 page 33 page 34 page 36 Population summary (Part one) Cheshire West and Chester Joint Strategic Needs Assessment Population aged under 25 (2013) 30% 30.5% 28.3% 30.3% 29.5% 35,000 28.9% 24.9% 25% Number aged under 25 Percentage of Population 35% Number 30,000 25,000 20% 20,000 15% 15,000 10% 10,000 5% 5,000 0% England Cheshire West and Chester Ellesmere Port Source: ONS Mid Year Population Estimates 2013 Rural Chester Neighbourhood Localities Northwich and Winsford 0 An estimated 93,800 children and young people aged under 25 live in Cheshire West and Chester accounting for 28.3% of the total population. In comparison, under 25s make up 30.5% of the overall England population. Of the four localities in Cheshire West and Chester, Northwich and Winsford has the highest number of under 25s (n=29,100) followed by Chester (n=24,500). Ellesmere Port locality has the smallest number of children and young people aged under 25 (n=17,800). As a percentage of the total population, Chester locality has the highest proportion of younger people with (30.3%) of residents aged under 25. This is influenced largely by the student population in the Garden Quarter and surrounding areas of the University of Chester. In Rural locality just 25%, or one in four of the population are aged under 25. The number of children aged 0 to14 was 54,300 in 2012, and is forecast to increase by 8% to 58,700 by 2022. Most of this increase is forecast to be in children aged 5 to 11. At locality level Northwich and Winsford locality is forecast to see the greatest increase (1,700 children or an increase of 9% between 2012 and 2022). All localities are forecast to see an increase in the 0 to14 population. Proportion of total population aged under 25 in 2013 England Cheshire West and Chester 18,300 0% 18,400 5% 17,700 10% 00-04 19,600 15% 05-09 20% 10-14 19,800 25% 15-19 30% 35% 20-24 Source: ONS Mid Year Population Estimates 2013 Further data are available in our locality dashboard and children’s centre dashboards 1 Population Summary (Part two) Cheshire West and Chester Joint Strategic Needs Assessment majority (67%) of children and young people living in the area covered by Cherry Grove children’s centre live in areas considered amongst the 20% least deprived in England. 0% 20% Q1 Q2 40% Q3 19,000 Q4 60% Q5 30,600 80% 100% Source: Department for Communities, ONS Mid Year Estimates 2013 Further data are available in our locality and children’s centre dashboards England 75% 70% 60% 50% 40% 30% 20% 10% 2% 0% 5% 2% White: White: British Other 5% 10% 0% 2% Mixed Asian 5% Black 0%1% Other ethnic group Source: 2011 Census Lone parent households with dependent children 24% 23% 25% 28% 23% Rural 17% Chester 30% 25% 20% 15% 10% 5% 0% Northwich & Winsford 13,600 80% Ellesmere Port 12,900 Cheshire West and Chester Cheshire West & Chester England 94% 90% % of households with dependent children The 2011 Census also showed there were 9,000 lone parent households in Cheshire West and Chester with dependent children aged 0 to18. This was 23% of all households with dependent children, and was lower than the national average of 24%. The highest rate was in Ellesmere Port locality (28%) and the lowest in Rural locality (17%). At ward level the rates ranged from 44% in Grange (Ellesmere Port) to 10% in Kingsley (Rural). Population aged under 25 living in areas of deprivation (IMD2010 national quintiles) 17,600 100% Analysis of the 2011 Census shows that 94% of our children and young people were classified as White British. This was higher than the England average of 75%. The remaining 6%, or 5,700 out of the borough’s 93,800 children and young people, who are not ‘White British’ were from other minority ethnic backgrounds. This includes Asian, Black, mixed race and White Other (which can include Irish, Gypsy or Irish traveller). Compared to England as a whole, Cheshire West and Chester has a lower proportion of children and young people living in more deprived areas. Analysis of children’s centre populations however shows local variation. Portside children’s centre covers areas where 100% of under 25s live in areas considered to be amongst the 40% most deprived in England. The proportion is 92% in Blacon and 83% in Winsford Over. In contrast, the Cheshire West and Chester Ethnicity of under 25s England Locally we have found that there is a distinct difference in health experience between residents living in areas considered to be amongst the 40% most deprived in England and the rest of the Cheshire West and Chester population. The life expectancy for babies born in our more deprived areas is significantly lower than the rest of the population. Around one in three (33%) of our children and young people live in our more deprived areas (IMD 2010 national quintiles one and two). This is higher than for the overall population, of which 29% live in our more deprived areas. Localities Source: 2011 Census 2 PHOF 1.01ii - Children in poverty (under 16s) Percentage of under 16sin low income families (children living in families in receipt of out of work benefits or tax credits where their reported income is less than 60% median income) Cheshire West and Chester Joint Strategic Needs Assessment Proportion of children in poverty (under 16 years) 2011 30 25 20 NHS West Cheshire Evidence of what works NHS Vale Royal Worst LA Best LA 40 35 Localities Chester Northwich and Winsford 45 Cheshire West and Chester Ellesmere Port Marmot concludes that giving a child the best start in life is crucial to reducing inequalities across the life course. What happens in these early years, whilst the foundations of human development are being laid down has lifelong effects on many aspects of health and wellbeing. To have an impact on inequalities there is a need to address the social gradient in children’s access to positive early experiences and even greater priority must be given to ensuring expenditure early in the developmental life cycle that is on children below the age of five years. 15 10 5 0 English Local Authorities with local geographic areas Source: HM Revenue and Customs (Personal Tax Credits: Related Statistics - Child Poverty Statistics) Localities as at May-13 Cheshire West and Chester has lower rates of children living in poverty compared to England and sits in the second best quartile of ranked Local Authorities in England. Year on year trends have shown Cheshire West and Chester child poverty rates have risen slightly from 15.8% in 2006 to 16.3% in 2011, this goes against the national and regional trends which show a slight decline. Locally there is some variation amongst localities with higher rates of child poverty in Ellesmere Port locality (21.1%) and lower rates in the Rural locality (8.3%). Vale Royal CCG has higher rates of child poverty compared to West Cheshire CCG. Though Cheshire West and Chester experiences relatively low child poverty compared to England, at a very local level some small areas record rates in excess of 40%. Recommended actions • Ensure expenditure on early years development (physical, emotional and intellectual) is focussed progressively across the social gradient. • Prioritise pre and post natal interventions that reduce the adverse outcomes of pregnancy and infancy. • Ensure those with children in the first year of life are able to maximise their income to support healthy living. • Provide routine support to parents through parenting programmes and implement programmes for the transition to school. • Provide good quality early years education and childcare proportionately across the social gradient. Cheshire West and Chester, Children in 'poverty' (under 16s), 6 year trend England 30 % of Children in poverty Rural Proportion of children in poverty (Under 16 years) 50 North West Cheshire West and Chester 25 20 15 10 5 0 2006 2007 2008 2009 2010 2011 Source: HM Revenues and Customs, Proportion of children living in families in receipt of CTC whose reported income is less than 60 per cent of the median income or in receipt of IS or (Income-Based) JSA. Rationale: Child poverty is an important issue for public health. The Marmot Review (2010) suggests there is evidence that childhood poverty leads to premature mortality and poor health outcomes for adults. Reducing the numbers of children who experience poverty should improve these adult health outcomes and increase healthy life expectancy. (Public Health England) 3 PHOF 2.02 - Breastfeeding prevalence Cheshire West and Chester Joint Strategic Needs Assessment 100% 90% Percentage of children breastfeeding at six to eight weeks 2013/14 Cheshire West and Chester Best LA 80% 70% 60% 50% 40% The 2013/14 prevalence data for Cheshire West and Chester has not been published in the Public Health Outcomes Framework as it did not meet NHS England validation rules, however it is included here in order to support local understanding. 30% 20% 10% 0% Source: Department of Health English Local Authorities Evidence of what works NICE guidance Maternal and Child Nutrition recommends a multifaceted approach to: •Raise awareness of, and how to overcome the barriers to breastfeeding. •Provide high quality and sufficiently skilled breastfeeding peer support programmes. •Joint working between health professionals and peer supporters. •Provide education and information for pregnant women. This is underpinned by the support for the adoption and implementation of UNICEF Baby Friendly Initiative (BFI) as the best evidence base to raise breastfeeding prevalence. Recommended actions Work towards increasing breastfeeding rates through actions outlined in the Infant Feeding Strategy: •Carry out targeted work in areas of low breastfeeding initiation and continuation. •Work towards achieving community and hospital full BFI status. •Provide breastfeeding peer support in hospital and community settings. •Continue to ensure the equitable provision of breastfeeding support groups across Cheshire West and Chester. Breastfeeding rates in Cheshire West and Chester are significantly worse than the England average and have been falling. During 2013/14 the proportion of mothers initiating breastfeeding at birth was 65.3% compared to the England rate of 73.9%. At six to eight weeks the proportion of babies being breastfed fell to 35.1%, also significantly lower than the national average of 45.9%. In very crude proportions this means that around a third of mothers do not initiate breastfeeding at all, a third will give up by six to eight weeks and around one third of babies are still being breastfed at six to eight weeks. 80% 60% We don’t have a complete picture at the locality or children's centre level, but information from 2011/12 suggests that breastfeeding rates are lower in Vale Royal CCG compared to West Cheshire CCG. Within West Cheshire CCG, Ellesmere Port and Neston has the lowest breastfeeding rates. Breastfeeding benefits both mother and child. Breast fed babies have less risk of; developing chest and ear infections, diarrhoea and vomiting, eczema; becoming obese, and developing diabetes later in life. For mothers breastfeeding reduces the risk of breast and ovarian cancer. Breastfeeding initiation and at six to eight weeks 69% 68% 68% 65% 37% 41% 39% 35% 2010/11 2011/12 2012/13 2013/14 40% 20% 0% Initiation England 6-8 Weeks England Initiation Cheshire West and Chester 6-8 Weeks Cheshire West and Chester Rationale: 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 infants. Current national and international guidance recommends exclusive breastfeeding for newborns and for the first six months of infancy. (Public Health England) 4 PHOF 2.6i - Excess weight in four to five year olds Percentage of four to five year olds classified as overweight or obese Cheshire West and Chester Joint Strategic Needs Assessment Excess weight in children aged four to five - 2012/13 35% Percentage of Children 30% Cheshire West and Chester West Cheshire CCG Vale Royal CCG Worst LA 25% Best LA 20% 15% 10% 5% 0% Evidence of what works Preventing and managing overweight and obesity are complex problems with no easy answers. NICE clinical guideline 43 offers practical recommendations based on evidence including: • Adopt a population approach with specific action for individuals. • Children and young people should eat regular meals including breakfast. • Encourage active play – dancing and skipping. • Make activity part of family life - walking to school, cycling to shops • Reduce sedentary activities – such as watching television. • Tailored intervention for those children and young people with BMI at or above 91st centile. English Local Authorities with local geographical areas Source: National Obesity Observatory, Local NCMP Data Recommended actions 1. Ensure a range of opportunities for children and young people to take part in formal and informal active play. 2. Ensure whole workforce are skilled and competent at raising and discussing healthy weight. 3. Utilise change4life brand and campaign material to encourage Almost 98% of our eligible children families to eat less and move more. participated in the national child measurement programme for Since 2007/08 the proportion of four to 4. Promote healthy food choices particularly around nutrition, 2012/13, a higher uptake rate than the five year olds who are overweight or weaning and breastfeeding. national average. Results show that obese in Cheshire West and Chester with a proportion of 24% of children has increased by five percentage Excess weight in children aged 4-5 years - Trend overweight or obese, Cheshire West points compared to a relatively stable 30% and Chester has a significantly higher national position. Excess weight has prevalence than the England average. increased faster in our less deprived 25% The proportion of children considered areas compared to our more deprived 20% obese (8.9%) is similar to England areas. (9.3%) with a significantly higher 15% Nationally, boys experience a higher proportion of overweight children prevalence of excess weight than girls 10% (15.1% compared to 13%). and this pattern is reflected locally but 5% Differences between Vale Royal CCG only by a small margin. Compared to the other girls in England, a and West Cheshire CCG are not 0% significantly higher proportion of our significant. There are differences 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 across the authority however, with our girls are overweight or obese. Cheshire West and Chester NHS West Cheshire CCG NHS Vale Royal CCG England more deprived areas having a Rationale: Excess weight (overweight and obesity) in children often leads to excess weight in adults, and this is recognised as a major determinant of premature mortality and avoidable ill health. 5 significantly higher proportion of children with excess weight than our less deprived areas. Differences are also evident when looking at children centre areas that range from 15% to 33% of four to five year olds with excess weight. Percentage of Children In 2012/13 just under one quarter of Cheshire West and Chester children in their school reception year were an unhealthy weight. Nine per cent of children in the age group were obese. PHOF 2.6ii - Excess weight in 10 to 11 year olds Percentage of 10 to 11 year olds classified as overweight or obese Cheshire West and Chester Joint Strategic Needs Assessment Excess weight in children aged 10 to 11 - 2012/13 50% Cheshire West and Chester West Cheshire CCG Vale Royal CCG Percentage of Children Worst LA 40% Best LA 30% 20% 10% 0% Evidence of what works Preventing and managing overweight and obesity are complex problems with no easy answers. NICE clinical guideline 43 offers practical recommendations based on evidence including: • Take a population approach with specific action for individuals. • Children and young people should eat regular meals including breakfast. • Make activity part of family life - walking to school, cycling to shops. • Reduce sedentary activities – such as watching television and playing computer games. • Tailored intervention for those children and young people with BMI at or above 91st centile. English Local Authorities with local geographical areas Source: National Obesity Observatory, Local NCMP Data In 2012/13 just under one third of Cheshire West and Chester children in their final year at junior school were an unhealthy weight. Almost 18% of children in this age group were obese. In Cheshire West and Chester, levels of obesity double between the reception year and final year of junior school. between CCGs are not significantly different. There are however significant differences in levels of excess weight for children in our more deprived areas. With levels of excess weight at 37% for 10 to 11 year old children living in our more deprived areas, the proportion is significantly higher than in our less deprived areas (28%). Recommended actions 1. Enable children and young people to build physical activity into daily life, e.g. walking or cycling to school. 2. Ensure there are a range of opportunities to minimise sedentary behaviour e.g. regular times to take part in formal or informal sport and activity. 3. Ensure children and young people have access to regular healthy meals, particularly breakfast. 4. Increase children and young people’s understanding of long term impacts of lifestyle decisions. Percentage of Children Over 95% of our eligible children took Excess weight in children aged 10 to 11 years part in the annual national child Trend measurement programme, a higher Nationally, boys have a significantly 40% uptake than the national average. higher prevalence of excess weight Recording 31% of children as either 30% compared to girls and in previous years overweight or obese, Cheshire West this has been reflected in Cheshire 20% and Chester was significantly lower West and Chester. In 2012/13 there than the England average. This is the 10% was no gender difference locally as first time levels of excess weight in our 31% of both boys and girls had excess year six children have been lower than 0% weight. There was a five percentage the England average since 2008/09. 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 point fall in excess weight for 10 to 11 There have been improvements for year old boys between 2011/12 and Cheshire West and Chester NHS West Cheshire CCG both CCGs but most notably for West 2012/13. NHS Vale Royal CCG England Cheshire CCG where the excess weight fell below Vale Royal CCG. Rates Rationale: Excess weight (overweight and obesity) in children often leads to excess weight in adults, and this is recognised as a major determinant of premature mortality and avoidable ill health. 6 PHOF 2.7 Hospital admissions caused by unintentional and deliberate injuries in children Cheshire West and Chester Joint Strategic Needs Assessment Unintentional & deliberate injuries - aged 0-14 - 2013/14 LA Localities Chester 150 NHS Vale Royal CCG Evidence of what works NICE identifies that approaches to preventing unintentional injuries are broad ranging, covering education, environmental modifications and regulation and legislation. The World Health Organisation argues that legislation has the greatest impact as a preventative measure. Rural 200 Ellesmere Port Crude Rate per per 10,000 250 NHS West Cheshire CCG Northwich and Winsford Cheshire West and Chester Most effective strategies use a combination of approaches and experience in European countries shows that positive leadership and a concerted effort can reduce the injuries. 100 Recommended actions 50 0 England local authorities compared with local geographical areas Source: Hospital Episode Statistics In 2013/14, there were 678 emergency hospital admissions for an injury among Cheshire West and Chester children under the age of 15. Per head of population in this age group, and for children aged under five years, the admission rate is significantly higher than the England average. The majority (84%) of injuries were unintentional. and were most commonly head injuries, either superficial or nonspecific, caused by a fall. Accidental poisoning accounted for 12% of admissions in under fives and 4% were for injuries caused by transport accidents. • Demonstrate the duty to promote children's safety by incorporating unintentional injury prevention in local strategic plans. • Identify or establish a forum with senior leadership support to plan, coordinate, action and monitor injury prevention activities (at home on the road and outdoor) across partners. • Ensure whole children's workforce have skills knowledge and competency to inform educate and support parents on injury prevention at home, on the road and outdoors • Prioritising houses at greatest risk, provide home safety assessments; supply and install home safety equipment together with education and advice. Inner circle 0-4 Cause of injury admission 0-4 and 5-14 year olds 2013/14 In the five to 14 year olds fewer injuries occur in the home (28%) whilst Outer circle 5-14 14% occur in school. The largest 3% proportion of injuries are still caused Admission rates have fallen since Transport accidents 14% by falls, resulting in both head injuries 2011/12, most notably in Chester and fractured limbs, but the proportion locality, however Ellesmere Port Accidental poisoning caused by transport accidents remained significantly higher than the 25% 8% 4% 5% 12% England average. Children in our more increases to 14%. Most transport Assault 2% accident admissions are pedal cyclists deprived communities continued to have significantly higher rates of injury (71%), half traffic related, half not. In Falls admission compared to children in our this age group 12% of injury 37% admissions are due to intentional self less deprived areas in 2013/14. Intentional self harm harm. 39% The type of injury and the place where 12% Other causes of accidental Cheshire West and Chester would it occurs differs by age group. Of the 678 admissions in 2013/14, 46% were need to have around 68 less injury incl. undetermined intent 39% children aged under five years. In this admissions a year to have a lower Other / no cause given admission rate than the 2013/14 young age group, over half of the England average. injuries occurred in the home (52%) Rationale: Injuries are a leading cause of hospitalisation and represent a major cause of premature mortality for children and young people. They are also a source of long-term health issues, including mental health problems related to experience(s) of injury. (Public Health England) 7 PHOF 2.7 Hospital admissions caused by unintentional and deliberate injuries in young people Cheshire West and Chester Joint Strategic Needs Assessment Unintentional & deliberate injuries - aged 15-24 - 2013/14 300 250 200 150 LA Localities Rural 350 Chester 400 NHS Vale Royal CCG Ellesmere Port NHS West Cheshire CCG Northwich and Winsford Crude Rate per per 10,000 Cheshire West and Chester 100 50 0 England local authorities compared with local geographical areas Source: Hospital Episode Statistics In 2013/14, there were 500 emergency hospital admissions for an injury among Cheshire West and Chester young people aged between 15 and 24. Per head of population in this age group the admission rate is lower than the England average, but not significantly so. None of our localities or CCGs appear significantly different to the England average. West and Chester. A large proportion (41%) of injury admissions in young people were for a deliberate injury, most commonly self harm by poisoning. Overall, intentional self harm accounted for 34% of admissions (n=169) in 15-24 year olds during 2013/14 and 91% of these were for poisoning. In this age group 18% of injuries occurred in the home with the Our more deprived communities majority occurring elsewhere. The however do have a different majority (70%) of the 54 experience of injury related admissions caused by transport admissions. Young people living accidents were traffic related in our more deprived areas had a largely involving car occupants, significantly higher admission rate motorcyclists and pedal cyclists, a for unintentional and deliberate smaller proportion were injures in 2013/14 than their peers pedestrians. living in other areas of Cheshire Evidence of what works Regarding self-harm, NICE have highlighted gaps in the underpinning evidence around effectiveness of staff training, the value of risk scales, psychological therapies and psychosocial interventions and harm-reduction strategies. For children and young people, NICE recommend a full assessment of the person's family, social situation, and child protection issues where appropriate. In general, particularly for adults, it is generally accepted that acts of selfharm should be taken as evidence of suicidal intent until proven otherwise. Recommended actions • Identify or establish a forum with senior leadership support to plan, coordinate, action and monitor injury prevention activities (at home on the road and outdoor) across partners. • Children and young people who self-harm should receive treatment from within the Child and Adolescent Mental Health services (CAMHS). Access to services should be based on clinical need. • A multi-agency approach should be adopted to ensure all perspectives of the young person’s life are considered when young people (who selfharm) are referred under local safeguarding procedures. • All professionals should work collaboratively to minimise any potential adverse impact when transferring to adult services. Cause of injury admission in 15-24 year olds 2013/14 (n=501) Transport Other / no accidents cause given 11% 8% Accidental Other causes of accidental injury incl. undetermined intent 22% poisoning 6% Assault 7% Falls 12% Intentional self harm 34% Rationale: Injuries are a leading cause of hospitalisation and represent a major cause of premature mortality for children and young people. They are also a source of long-term health issues, including mental health problems related to experience(s) of injury. (Public Health England (PHE)) 8 500 400 Chester Rural 600 Emergency hospital admissions for children (aged under 19) with lower respiratory tract infections (2013/14) Northwich & Winsford 700 Ellesmere Port DSR per 100,000 resident population NHSOF 3.2 Emergency admissions for children with lower respiratory tract infections Cheshire West and Chester Joint Strategic Needs Assessment 300 200 100 0 English Local Authorities with local geographical areas Localities Cheshire West and Chester NHS Vale Royal CCG NHS West Cheshire CCG Evidence of what works Bronchiolitis is the most common disease of the lower respiratory tract during the first two years of life. Usually caused by respiratory synctial virus (RSV), cases are generally mild but can be severe and follow a seasonal pattern (peaking during the winter). Although death is rare, a small proportion of cases will need to be admitted to hospital. The majority of children can be managed at home under the direction of the GP. Only the severe cases (as assessed by the GP) will need to go to hospital. Source: Hospital Episode Statistics, ONS Mid Year Population Estimates In 2013/14 there were 281 emergency hospital admissions for children aged under 19 with lower respiratory tract infections in Cheshire West and Chester. As a rate per head of population, Cheshire West and Chester had a significantly higher admission rate than the England average. Rates for both Vale Royal and West Cheshire CCGs were also significantly higher than England. Within Cheshire West and Cheshire there is local variation but no significant differences between localities or CCGs. Children living in our more deprived areas have a higher rate of admission than their peers in other areas of Cheshire West and Chester but rates in these areas decreased between 2012/13 and 2013/14 compared to an increase in our less deprived areas. Differences are not statistically significant. Ellesmere Port locality and Northwich and Winsford locality have significantly higher rates than England and are comparable with the worst 25% of local authorities nationally, the lowest rates locally are in the Rural locality. Over 90% of children admitted were aged under five. This is a similar age profile to England. The majority (85%) of admissions had a primary diagnosis of bronchitis, the rest were for pneumonia, there were no admissions for influenza. Recommended actions NICE are publishing guidance on the diagnosis and management of bronchiolitis in children in May 2015. Treatment is generally supportive and can be managed by parents or carers with the GP being used to identify the severe cases (as characterised by respiratory distress , lethargy, poor feeding or reduced oxygen saturation.) There is some evidence that cold, damp or mouldy housing exacerbates respiratory illnesses in children. It is not unreasonable to suggest that housing refurbishment and fuel poverty reduction schemes be targeted to those areas with affected children. Rationale: Lower respiratory tract infections in children should not in general require hospital care. This indicator is a proxy for looking at how effectively the NHS is managing this condition. (Health and Social Care Information Centre (HSCIC), 2014) 9 NHSOF 2.3ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Cheshire West and Chester Joint Strategic Needs Assessment 500 400 300 For diabetes, current NICE guidance suggests appropriate patient education, dietary advice, psychological support and management of complications. This guidance is currently under review (expected publication - August 2015). Rural 600 Recommended actions For asthma, NICE make a number of recommendations on treatment in its quality standard. These include : an annual structured review, objective measurements of severity, specialist review and GP follow up after admissions for acute exacerbations. Chester 700 Ellesmere Port 800 Northwich & Winsford DSR per 100,000 resident population Diabetes, epilepsy and asthma admissions - 2013/14 200 For epilepsy, the NICE guideline key priorities include having the initial diagnosis by a specialist, a comprehensive care plan, an annual (at least) review by a specialist and prompt referral to a tertiary service if the diagnosis is uncertain or uncontrolled epilepsy. 100 0 English local authorities with local geographical areas Cheshire West and Chester NHS West Cheshire CCG NHS Vale Royal CCG Localities Evidence of what works Source: NHS Indicator Portal, Hospital Episode Stations, ONS Mid Year Population Estimates Locally, the highest rate was in Northwich and Winsford (436 per 100,000), significantly higher than the England average. Our more deprived areas have rates that are 25% higher than in our less deprived areas however the rates are not significantly different. Cheshire CCG, and in 2013/14 the rate for Vale Royal CCG was 50% higher than West Cheshire CCG, a significant difference. For Cheshire West and Chester, as a whole, there have been increases in recent years. However, over the longer term there were 50 less admissions for asthma in 2013/14 than in 2008/09, a 26% reduction. Asthma accounts for the largest proportion (56%) of these admissions, followed by epilepsy (26%) and the remainder due to diabetes (18%). Admissions for asthma and epilepsy are more common in the children aged under 10 while diabetes admissions tend to occur in older children, only 5% of 0-4 admissions in this cohort were for diabetes. Around one in 11 children are known to have asthma. In general, it has been estimated that a large proportion of asthma-related emergency department attendances and even deaths could have been prevented by early interventions. Most children with diabetes are type one (insulin dependent). Clearly, the quality of their ongoing care is paramount to prevent complications, morbidity and resultant NHS activity for this life time condition. However, NICE have noted that fewer than 20% of children receive the basic care as recommended in their guidelines. There are many different types and presentations of epilepsy. The diagnosis is easily confused and sometimes completely wrong. Obtaining a correct diagnosis (and thus treatment) is important as the disease can have a wide-ranging impact on the child’s health and lifestyle. Asthma, epilepsy and diabetes admission trend, Cheshire West and Chester DSR per 100,000 In 2013/14 there were 241 admissions to hospital for children in Cheshire West and Chester due to asthma, diabetes or epilepsy. Cheshire West and Chester is in the worst 50% of local authorities for emergency admissions related to these conditions. 400 Asthma Admission rates have fluctuated Epilepsy 200 locally and trends differ between the Diabetes two CCGs. Over time, Vale Royal CCG has generally experienced 0 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 higher admission rates than West RATIONALE: This outcome is concerned with how successfully the NHS manages the conditions through looking at unnecessary hospital admissions. Nationally, asthma, diabetes and epilepsy account for 94% of emergency admissions for children (under 19) with long term conditions. (HSCIC, 2014)10 Sexually transmitted Infections (STIs) and young people aged under 25 Cheshire West and Chester Joint Strategic Needs Assessment 4000 STI prevalence (per 100,000) young people compared to Cheshire West and Chester, 2012 3,800 3000 2,272 2000 1000 584 64 0 Under 15 15 to 19 20 to 24 All CWAC Rateof STIs per 100,000 Source: Public Health England, 2013 The most common sexually transmitted infections (STIs) diagnosed in Cheshire West and Chester are Chlamydia and Genital Warts. Except for Gonorrhoea, the number of diagnosed cases of most STIs has fallen and rates of infection are lower than those for the North West and England. Young people in England, under the age of 25, continue to be disproportionately affected by STIs accounting for 64% of all Chlamydia, 54% of Genital Warts, 55% of Gonorrhoea and 43% of Herpes infections in 2012. In Cheshire West and Chester (2012), the 20-24 age band have the highest overall prevalence of acute STIs (3,800 per 100,000 population) with the 15-19 age band having the second highest prevalence (2,272 per 100,000 population). A number of factors have been identified which can lead to increased risk of acquiring STIs: • Unprotected sex • Frequent change of and/or multiple sexual partners • Alcohol or substance misuse leading to ‘risky’ sexual behaviour (unsafe and regretted sex). Amongst young people aged 15 to 19 prevalence in females is over three times the prevalence in males. Public Health England recommends that local areas should be achieving a rate of 2,300 Chlamydia diagnoses per 100,000 15 to 24 year old resident population annually. A total of 10,580 Chlamydia tests were reported to the National Chlamydia Screening Programme in Cheshire West and Chester in 2012, of which 809 (7.6%) were positive. The crude rate of Chlamydia diagnoses in Cheshire West and Chester was 2,045 per 100,000 young adults aged 15 to 24 years, a similar rate to the England average of 1,979 per 100,000 young adults but less than the recommended rate. Evidence of what works The Government has set out its ambitions for improving sexual health in its publication ‘A Framework for Sexual Health Improvement in England’ (2013). This recognised that while individuals’ needs may vary, there are certain core needs: • Preventative interventions that build personal resilience and selfesteem and promote healthy choices. • Access to accurate and timely information that helps people to make informed decisions about relationships, sex and sexual health. • Rapid access to confidential, integrated health services, in a range of settings, accessible at convenient times. • Early accurate and effective diagnosis and treatment of sexually transmitted infections (STIs), including HIV, combined with the notification of partners who may be at risk. Recommended actions • • • • • Chlamydia screening - Further targeted roll out of the national programme is crucial to achieve the diagnostic target of 2.3% positivity in 15 to 24 year olds Community focused STI screening services - Access to STI screening in communities is an important focus of service development. It is vital to encourage and develop opportunities to ensure this continues, for example, GP new patient screening Prevention - The ability for young people to make positive lifestyle changes and minimise risk as a result of health promotion interventions. This includes the provision of information and advice, promotion of key sexual health messages, educational and awareness sessions, distribution of safer sex materials and outreach work. Young people’s sexual health services ; additional services require development, linked to those young people who are at risk, or deemed hard to reach, as they do not access mainstream services. Services need to be ‘You’re Welcome’ accredited within nine months of establishment Sexual health is patterned by socioeconomic inequalities, with those from deprived areas and men who sleep with men being those most at risk of negative outcomes. Rationale: Sexual health is an important part of physical and mental health. Essential elements of good sexual health are equitable relationships, and sexual fulfilment with access to information and services to avoid the risk of unintended pregnancy, illness and disease (Public Health England, 2013). 11 PHOF 2.04 Conceptions in women aged under 18 Crude rate per 1,000 females aged 15 to 17 Cheshire West and Chester Joint Strategic Needs Assessment Cheshire West and Chester 30 Rural 40 Localities Chester 50 Northwich and Winsford 60 Ellesmere Port Rate per 1,000 women aged 15-17 Under 18 Conceptions (2010-12) 20 10 0 English local authorities and local geographical areas Source: ONS © Crown Copyright, ONS Mid Year Population Estimates Note: Whisker lines on locality data show 95% confidence intervals, based on an equal distribution of the total number of supressed conceptions across wards. During the three years 2010 to 2012 there were 516 conceptions amongst women aged under 18 in Cheshire West and Chester. This equates to a rate of 30.3 per 1,000 women aged 15 to 17, similar to the England rate of 30.9 per 1,000. Half (49%) of the pregnancies ended in abortion. There are significant local disparities in the rate of under 18 conception. Both Chester and Rural localities are lower than the England average (Rural significantly so). The lowest rates of under 18 conception can be found in our less deprived areas. Three wards (Davenham and Moulton, Handbridge Park and Tarvin and Kelsall) all had rates significantly lower than the England average. Ellesmere Port locality had the highest rate within Cheshire West and Chester. The rate of 41 per 1,000 (n=133) made it the only locality that was significantly higher than the England average. Between 2009-11 and 2010-12 rates fell in England and in all Cheshire West and Chester localities except Ellesmere Port where the rate increased slightly. Eight electoral wards in Cheshire West and Chester were significantly higher than the England average. The highest was Rossmore in Ellesmere Port with a rate of 118.0 per 1,000 (n=19). The under 16 conception rate was 6.1 conceptions per 1,000 females aged 13 to 15 in 2010-2012. This is an increase from 2009-2011 (5.8 per 1,000) but is lower than the England rate of 6.3 per 1,000. Evidence of what works The Government has set out its ambitions for improving sexual health in its publication ‘A Framework for Sexual Health Improvement in England’ (2013). This recognised that while individuals’ needs may vary, there are certain core needs: • Preventative interventions that build personal resilience and self-esteem and promote healthy choices. • Access to accurate and timely information that helps people to make informed decisions about relationships, sex and sexual health. • Rapid access to confidential, integrated health services, in a range of settings, accessible at convenient times. Recommended actions Young people are a high risk group in terms of poor sexual health putting them at risk of unintended pregnancy. Recommended actions include: • Prevention - The ability for young people and adults to make positive lifestyle changes and minimise risk as a result of health promotion interventions. This includes the provision of information and advice, promotion of key sexual health messages, educational and awareness sessions, distribution of safer sex materials and outreach work. • Young people’s sexual health services - Additional services require development linked to those young people who are at risk or deemed hard to reach as they do not access mainstream services. Services need to be ‘You’re Welcome’ accredited within nine months of establishment. • Provision of Long Acting Reversible Contraception (LARC) Promotion and uptake of LARC will require improvement particularly around the audit of LARC removals. • Sexual health is patterned by socioeconomic inequalities, with those from deprived areas often being those most at risk of negative outcomes, such as sexually transmitted infections and unwanted pregnancies. Rationale: Most teenage pregnancies are unplanned and around half end in an abortion. As well as it being an avoidable experience for the young woman, abortions represent an avoidable cost to the NHS. And while for some young women having a child when young can represent a positive turning point in their lives, for many bringing up a child is difficult and often results in poor outcomes for both the teenage parent and the child, in terms of ;the baby’s health, the mother’s emotional health and well-being, and the likelihood of both the parent and child living in long-term poverty. (PHE) 12 School readiness Cheshire West and Chester Joint Strategic Needs Assessment School readiness is defined by Ofsted as having a firm grounding in a range of skills including communication. In Cheshire West and Chester, by the end of reception year, 61% of children achieved a good level of development (2013/14). This is similar to the England average of 60%. 2012/13 data show that by the end of reception year, 52.4% of children achieved a good level of development, similar to the England average of 51.7%. However, the percentage of children with free school meal status achieving a good level was 31%, this is significantly worse than the England rate of 36.2% (2012/13) (data for 2013/14 is currently unavailable). . 100% 80% 60% 40% 20% 0% Evidence of what works Ofsted examples of good practice: • • Percentage of children achieving a good level of development at the end of reception (2012/13) 51.8% 52.4% 36.2% • 31.0% • England Cheshire West and Chester All children England Cheshire West and Chester Children eligible for free Source: Public Health England, 2013 school meals The proportion of children receiving free school meals and considered ready for school was 21.4 percentage points lower than the average percentage considered ready for school in Cheshire West and Chester, in 2012/13. School readiness is also measured by the ability of the child to meet the expected level in a phonics screening check. The check consists of 40 words and non-words that the child will be asked to read. In Cheshire West and Chester, 74% of year one pupils achieved the expected level in the phonics screening check which is the same as the England average (2013/14). The percentage of children with free school meal status who achieved the expected level in the phonics screening check was 56%. This is significantly worse than the England average of 61%. School readiness % of children receiving a good level of development (2012/13) % of year one pupils achieving the expected level in the phonics screening check (2013/14) England Pupils eligible All pupils for free school meals 51.70% 36.20% 74% 61% Cheshire West and Chester Pupils eligible All pupils for free school meals 52.40% 74% 74 31% 56% • Providers who forge strong partnerships with parents and carers to develop the home learning environment, help improve the child’s progress. Vulnerable children need the best provision, but quality is often weakest in areas of highest deprivation. Providers who have quickly identified children at risk and supported parents through the transition period helps to reverse this trend Specific programmes of support and intervention to develop speaking, listening and communication skills, led by speech and language therapists. Staff speaking clearly, and understanding the importance of giving opportunities for children to speak, in sentences, to ask questions, and engage in role-play. Schools working with children’s centres to ensure gains made by disadvantaged children, in early years settings, are not set back over the summer holidays. Recommended actions Ofsted recommend: • • • • • Multi-agency working to engage vulnerable parents and target support where it is most needed. Providers working closely with parents and carers through the transition period, to increase parental understanding of what is expected in terms of school readiness and provide information and guidance on how best to get their child ready. Discrete adult-directed teaching sessions to small groups of children. Use of Pupil Premium funding to ensure the early identification and specialist support for children. Timely and accurate assessment of a child's baseline starting point. Rationale: Gaps in achievement between the poorest children and their counterparts are clearly established by the age of five. There are strong associations between a child’s social background and their readiness for school on entry into year one. A number of children who start school 13 behind their peers will never catch up (Ofsted). Narrowing the gap in educational achievement Key stage two Cheshire West and Chester Joint Strategic Needs Assessment Percentage of children living in care at key stage two achieving level four or above in reading, writing and maths (2013) 88% 83% 82% Percentage of key stage two pupils achieving level four or above in reading, writing and maths (2013) Pupils whose first language is not English 100% 68% All other pupils 80% 77% 60% Pupils eligible for free school meals 53% 53% 54% 40% All other pupils 81% 40% 20% Pupils with SEN statements 18% Pupils with SEN but no statement 0% 36% All other pupils Source: Department of Education, 2013 88% 0% 20% 40% 60% 80% 100% Children All other in care: pupils: Reading Reading Children All other in care: pupils: Writing Writing Children All other in care: pupils: Maths Maths Source: Department of Education, 2013 Key stage two typically relates to pupils in schools at age 11. In Cheshire West Pupils whose first language is other than English have an 11 percentage and Chester, children and young people facing disadvantage perform point gap to their peers in achieving level four in reading, writing and significantly worse than their peers. maths. The percentage of pupils achieving level four or above at key stage two who In Cheshire West and Chester, there is also a consistent gap in are eligible for free school meals (FSM) is 27 percentage points lower than attainment between boys and girls. For maths the gap is small at one their peers not eligible for free school meals. The percentage gap has percentage point. The gap is largest for writing at nine percentage increased between 2012 and 2013 although has decreased since 2011. points. Percentage of boys and girls at key stage two achieving For children in care, achieving level four or above, the percentage point gap level four or above in reading, writing and maths (2013) ranges from 48 percentage points for writing, to 29 percentage points for maths. The percentage gaps have reduced between 2012 and 2013. Pupils with special educational needs (SEN) have the greatest gaps in attainment to their peers. The percentage of pupils with statements of SEN achieving level four or above is 70 percentage points lower than their peers, for those without statements the gap is 52 percentage points. Reading Writing Maths 30% 48% 29% Free school meals 17% 24% 19% SEN with statement 58% 71% 67% 85% 86% Boys: Maths Girls: Maths 86% 91% 80% 89% 80% 60% 40% Percentage gap in attainment with peers Children in care 100% SEN no statement 29% 51% 33% 20% 0% Boys: Girls: Reading Reading Boys: Girls: Writing Writing Source: Department of Education, 2013 Rationale: Children from poorer families are at risk of becoming poor adults unless the attainment gap with their peers is closed. Those who grow up in poverty, are less likely to be able to afford educational activities and resources, have parents who are more stressed and less well14 placed to help them with school work, and are more likely to leave school early and without a qualification (Joseph Rowntree Foundation). Narrowing the gap in educational achievement Cheshire West and Chester Joint Strategic Needs Assessment Pupils achieving five GCSE's A* to C or equivalent including english and maths (2013) All pupils 63% Girls Boys 68% 59% Pupils whose first language is English Pupils whose first language is not English 63% 56% Pupils not eligible for free school meals Pupils eligible for free school meals 67% 31% Pupils with no identified SEN Pupils with SEN no statement Pupils with SEN statement Source: Department of Education, 2013 72% 29% 12% 0% 20% 40% 60% 80% Evidence of what works Ofsted reports: • Poverty can lead to poor health and poor academic progress. A joined-up approach to tackling child poverty is crucial. • Providing support for children and families whose first language is not English is vital. Few attainment differences between ethnic groups remain at age five and none remain at age seven once this is considered. • A positive home learning environment can help counter the effects of poverty on children’s learning and parents should be supported. • Attending a pre-school has a positive impact on development, particularly for those from poorer backgrounds . • High quality early years provision has a positive impact on the cognitive and social development of young children that impacts on later learning. 100% • All looked after children need a Personal Education Plan of high quality and the effective use of Personal Education Allowances. In Cheshire West and Chester, 63% of pupils achieved five or more GCSEs grades A* to C or equivalent including english and maths. This is significantly higher than the national average of 60.8%. However, across the Borough gaps in attainment exist, often for those who are most disadvantaged. There is a 36.2 percentage point difference, between young people eligible for free school meals and their peers. The attainment gap is greatest for pupils with a statement of special educational needs at 60.2 percentage points. Differences in attainment exist between Cheshire West and Chester localities. In the Rural locality, 73.2% of pupils achieved five GCSEs A* to C including English and Maths compared to 53.2% in Ellesmere Port locality. All localities have a higher percentage of pupils achieving in 2012/13 than 2011/12. Percent achieved five GCSE's grade A* to C including English and Math's Recommended actions • • • • • • Locality Chester Ellesmere Port Northwich and Winsford Rural 2012/13 61.8% 53.2% 61.4% 73.2% 2011/12 57.8% 49.9% 60.2% 69.1% • • • • Ensure every school has data to understand their attainment gap. Primary heads to share good practice, peer challenge and support newly formed networks to work together to narrow the gap. Education Improvement Partnerships to discuss narrowing the gap, identify innovative practice and share this with the local authority. Senior officers from Ofsted to attend meetings of Primary and Secondary heads to share good practice that have led to successful narrowing of the gap. Secondary heads to engage in a review process where external coaches do a two day review of schools. Training for head teachers and governors about how best to use the Pupil Premium. Identify, monitor and challenge schools with the greatest gaps. Continue to deliver narrowing the gap conferences. Implement an improved target setting system A number of schools to carry out action research about how to use feedback effectively and help to narrow the gap. Rationale: Although some do well, in comparison to their peers, children in care, those from poorer backgrounds, children who’s first language is not English and those with special educational needs have lower educational outcomes. This can impact on future life choices and opportunities (Ofsted). 15 School attendance Cheshire West and Chester Joint Strategic Needs Assessment 2011/12 Cheshire West and Chester England 2012/13 Primary – Secondary Percentage of Percentage of sessions missed sessions missed 4.2 6.1 4.4 5.9 Primary Secondary Percentage of Percentage of sessions missed sessions missed Total percent Persistant absence (15% or more absence) 5.1 5.2 5.1 5.2 Persistant absence (15% or more absence) Total Cheshire West and Chester 4.6 6.1 5.3 4.9 England 4.7 5.8 4.9 4.6 Cheshire West and Chester saw an increase in the percentage of pupils who were absent from 2011/12 (5.1% of sessions missed) to 2012/13 (5.3% of sessions missed). This is higher than the England average of 4.85% of sessions missed. The change is due to an increase of pupil absence at primary school which increased from 4.2% of sessions missed to 4.6% of sessions missed. Whole year data is not yet available for 2013/14. However, data for the autumn/spring term 2013/14 indicates a significant reduction in pupil absence from autumn/spring term 2012/13 from 5.6% of sessions missed to 4.32% of sessions missed. Persistent absence is a 15% absence or more for the year. Persistent pupil absence decreased in Cheshire West and Chester from 5.2% in 2011/12 to 4.9% in 2012/13. However, it is above the England average of 4.6% absences. Absence in Cheshire West and Chester schools Number of schools Education welfare works with schools, pupils, and their parents/carers to improve school attendance. Education Welfare Officers hold regular liaison meetings with attendance leads in schools, in which individual pupils attendance is reviewed and where pupils with attendance concerns are identified and actions are agreed. Welfare Officers support schools in their policies and strategies to address absence. Cases that fail to improve are considered for referral to Education Welfare. Following referral, Welfare Officers liaise between the family and school and assist the pupil in their return to regular attendance at school, often working with other agencies via Team Around the Family, Children in Need or Child Protection Plans. Green –Attendance above 95% Amber – Attendance 93%-95% Red – Attendance below 93% In 2012/13 there were 20 court parental prosecutions for a child's regular absence from school. There has been an increase in the number of schools successfully improving pupil absence between Summer term 2013 and Summer term 2014. Employers of young people, from age 13 to the end of compulsory school, are required to have youth employment licences the for young people they employ. For 2013/14 Employment licences were issued for 214 children and 1768 children were licensed to perform in entertainment. Evidence of what works • Education Welfare Officers based in each locality to work with schools, pupils and their parents/carers to improve school attendance. • Education Welfare Officers holding regular liaison meetings with attendance leads in schools. • A multi-agency approach to identify needs and agree an action plan. Rationale: Education welfare works with schools, pupils and their parents/carers to improve school attendance. Regular absences from school can affect future attainment levels, general well being, increase the chances of being involved in anti-social behaviour and being NEET. 16 Special Educational Needs (SEN) Cheshire West and Chester Joint Strategic Needs Assessment In Cheshire West and Chester, the greatest numbers of children with SEN statements were due to Autistic Spectrum Disorder, cognition and learning and behavioural, emotional and social difficulties. There has been an increase in the number of pupils with SEN statements in Cheshire West and Chester for those with cognition and learning difficulties, speech and 1580 language difficulties, Autistic Spectrum Disorders and behaviour, social and emotional difficulties. Number of pupils with statements of SEN in all schools (Cheshire West and Chester) 1700 1650 1680 1600 1529 1538 1550 1513 1500 From 1 September 2014 there will be no new statements of SEN and current statements will be transferred to Education, Health and Care plans. 1450 1400 Cheshire West and Chester statement population by SEN (Summer 2014) Autistic Spectrum Disorder Children with special educational needs have a statement of Cognition and learning SEN if the Local Authority decides the child’s needs cannot be Behaviour, emotional and social difficulty 256 met within the classroom using the resources typically available Speech, language and communication 227 within the school. Severe learning difficulty 135 Physical disability 107 Up to the 31 August 2014, Cheshire West and Chester Medical 45 undertook statutory assessments of a child’s Special Educational Profound and multiple learning difficulty 27 Needs (SEN). At 31 August 2014 there were 1,450 children and Specific learning difficulty 26 young people aged two to 19 years with statements of SEN in Hearing impairment 22 schools and early years’ provision in Cheshire West and Visual impairment 13 Chester. The percentage of Cheshire West and Chester pupils Multi-sensory impairment 7 Jan-10 Jan-11 Jan-12 Jan-13 Jan-14 Source: Department of Education, 2013 with SEN statements is 3%, slightly higher than the national average of 2.8%. The number of assessments resulting in a statement of SEN has been increasing each year. In 2013-14, there were 155 statements of SEN issued. The academic year of 2014 showed a 14% drop in statements of SEN (this drop in numbers may be due to changes in national funding arrangements for SEN introduced in April 2013). 334 315 0 50 100 150 200 250 300 350 400 Number of children and young people with statements Recommended actions • Ensure data is shared to inform commissioning of services for education, health and care provision. •Setup more detailed data collection, showing therapy services in the statutory plan to ensure block contracts meet need. •Ensure workforce has the skills, knowledge and competency to inform statutory assessments, detail appropriate outcomes for children and young people and monitor progress. •Ensure data is used to inform provision development in line with the council vision to educate Cheshire West and Chester young people close to home. The number of pupils with special educational needs without a statement has been decreasing. At January 2014, 6,625 pupils (13%) had special educational needs without a statement compared to 7,215 pupils (14.1%) in January 2013. Rationale: Children and young people with special educational needs (SEN) have learning difficulties or disabilities that make it harder for them to learn than most children and young people of the same age. Types of SEN are very varied and those with SEN may need extra help because of their type of need. Those who have a statement of SEN are ensured to get the right support and have their needs identified through their schooling. 17 Special Educational Needs (SEN) Cheshire West and Chester Joint Strategic Needs Assessment 93 10 Pupils educated out of Borough in independent or non maintained schools 23 1 80 13 2 0 126 59 8 38 1 2 3 2 1 0 18 0 0 4 2 0 50 0 12 5 193 582 3 51 School attendance of children with Special Educational Needs Attend special schools 786 Attend Resourced Provision Primary Nature of primary need 75 Attend Resourced Provision Secondary Pupils educated in Borough 13 Independent non-maintained special schools 60 Attend other authority mainstream school 36 Attend other authroity Resourced Provision 9 Attend other authority special schools 22 Electively home educated 9 0 200 400 600 800 The majority of children with special educational needs attend their local school and will receive the additional support they need. Approximately 80 children attend maintained mainstream schools with additional resources and staff called Resourced Provisions. Currently in 2014, Cheshire West and Chester has nine to 10 primary schools and one secondary school with Resourced Provision. Cheshire West and Chester has ten special schools in the Borough, all judged to be good or outstanding by Ofsted. Some of the schools have large numbers of children attending who live in Cheshire East. A number of children attend independent and non-maintained special schools (INMSS), reasons for attending include specialist care placements for looked after children, very specialist educational needs such as full sensory provision, or insufficient places available in the borough to meet specific needs. The number of places is commissioned by the local authority for maintained schools and the Education Funding Agency (EFA) for academies. Specialist provision is funded on a place plus system with every agreed funded place commissioned at a rate of £10k (the place cost) and an additional amount to meet individual pupils needs (the top up place cost). In 2013, Cheshire West and Chester completed a review of its special education provision which resulted in additional provision being built and a new secondary resourced provision. Autism Medical Behaviour, social and emotional difficulties Hearing impairment Dyslexia Severe learning difficulties Moderate learning difficulties Multi-sensory impairment Physical difficulties Profound and multiple learning difficulties Specific learning difficulties Speech, language and communication difficulties Visual impairment Total Total CWAC pupils Pupils educated out of Borough in other LA maintained schools Non-CWaC pupils educated in Borough 5 51 4 18 15 9 5 0 0 23 48 5 49 1 38 0 207 207 Recommended actions • Ensure that information about changes to provision are shared across all services to ensure specialist support and therapies are in place to meet changes in provision needs. •Ensure all workforce are aware of the type of needs supported by each school, and the place commissioning process. •Ensure that the workforce is aware of the transport policy for SEN. •Ensure that all workforce use the Local Offer to setup services and support and signpost parents. •Place data is used to monitor and develop provision and ensure best value for money within allocated budget. Rationale: Many children with SEN require extra support at one time or another during their school career. Most will attend their local school with their needs being me from existing resources. However, a small number will need extra help throughout their school career. 18 Young People not in education, employment or training (NEET) Cheshire West and Chester Joint Strategic Needs Assessment In 2013, 4.1% of Cheshire West and Chester’s 16 to 18 year old cohort were NEET equating to 450 young people. This is a decrease from 4.5% in 2012 and lower than the England average of 5.7% (percentages are based on the national measurement of NEET which is the average percent across the three months of November, December and January). Of the 46 wards in Cheshire West and Chester, 33 are at, or lower than, the NEET percentage for the entire authority (4.1%). Grange and Rossmore wards in Ellesmere Port locality, Elton in Rural locality and Lache in Chester locality all currently have a NEET percentage more than double that of the Local Authority. The use of a risk identification tool may have contributed to a reduction in the percentage of NEET year 11 There are concentrations of NEETs in certain parts of Cheshire West and leavers in 2013 to 2.1% from 2.4% in Source: Department for Education, 2013 2012. Chester, particularly in Ellesmere Port. Evidence of what works Recommended Actions The Children and Young People Critical Issue recommends: Factors that contribute to a young person becoming NEET include • Continued development of the ‘Risk of NEET’ indicator tool and its roll disadvantage, poor educational attainment and educational disaffection. out to schools. Evidence suggests the following approaches can have an impact: • Identify gaps in provision taking into account available courses and • Development and use of a ‘Risk of NEET’ tool to identify young locality areas. Ensure provision meets interests and aspirations of people in school year 11 to undertake preventative work to ensure our learners and fills the skills gap. they make a successful transition into post 16 participation. • Identify the requirements of employers in response to trends in • NEET case conferencing with opportunity providers helps match employment. Take into account projected skills gaps and young people to activities and aims to prevent young people moving employment shortage areas/localities using LMI data. All education from one provision to another without a clear progression route. providers need to be working closely with businesses to understand • The Apprenticeship Hub across Cheshire and Warrington is able to the qualities, skills and attitudes, besides qualifications, that young promote apprenticeships across the borough and encourage local people need to be successful in the workplace. businesses to take on apprentices. Currently there are over 800 • Develop clear and coherent progression routes for those age 14-19. apprentices in Cheshire West and Warrington. • Intensive, tailored support for the most vulnerable NEET young • The joining up and closer working with other services including people who may not be ready for traditional further education or Midwives, Youth Offending Team, Education Welfare, Family apprenticeship schemes. For example teenage parents often require Advocates, Social Care and Family Support Workers. This has up to date information and knowledge about benefits, housing advice helped reduce the number of NEET young people and increased the and support. support NEET young people receive. Rationale: Young people who are disengaged at aged 16-17 and are not in education, employment or training (NEET) are more at risk as adults to be unemployed or on a low income, develop poor mental health such as depression and live in poverty. The individuals are also at greater risk of experiencing intergenerational poverty: suffering from low aspirations and poor life chances which they in turn can pass on to their own children. (Public Health England) 19 Children's Centres (Part one) Cheshire West and Chester Joint Strategic Needs Assessment There are currently 20 Children’s Centres located across Cheshire West and Chester. Children’s Centres across the borough had 79% of their cohort registered and 59% accessing services provided by, or delivered through Children’s Centres (including early years providers, children’s social care services and both universal and targeted health partners) between 1 April 2013 and 31 March 2014. This is an increase from the previous two years (2011/12- 38.5%, 2012/13- 42.5%). Each Children’s Centre footprint is broken down into Super Output Areas (SOA) (small areas) which are ranked by the Indices of Multiple Deprivation (IMD). Within the borough there are 48 SOA’s which fall in the top 30% most deprived SOAs in the country, housing some of the Borough’s most vulnerable families. There are 5255 children aged 0 to four living in these deprived SOAs across the borough. Statutory guidance requires Children’s Centres to focus resources on these areas. As part of the Children’s Centre inspection process Ofsted inspectors must ‘judge whether the centre(s) have identified the specific needs of families living in the footprint area, and how well the centre and its partners have addressed the needs of the family and enable them to improve their lives. In addition, inspectors must judge if a centre has ‘an appropriate balance of services including those offered to all families, known as universal services, and targeted provision’. As of 31 March 2014, Children’s Centres across the borough had 89% of these 5255 children registered and 74.8% had accessed a service provided by or delivered through a Children’s Centre or its partners between 1 April 2013 and 31 March 2014. Similar to overall reach this is an increase compared to previous years (2012/13- 48.2% and 2011/12- 47.7%). Data shows that some footprints have very low levels of reach and registration, demonstrating the needs of children and families with multiple and complex needs in these footprints are being met from other mainstream sources. Areas such as Hartford, Cherry Grove and Malpas, Farndon and Tarvin Children’s Centres have no super output areas in the Top 30% IMD and this is reflected in their overall reach being between 45% and 65% for 2013/14. Whereas Centres such as Blacon, Portside and Stanlow Abbey who have more IMDs in the top SOAs have an overall higher reach between 77%-79%. In addition, in 2014 Children’s Centres within Cheshire West and Chester have three key priorities to focus their resources on: • Children receiving two year funded nursery entitlement. • Children under five being managed as part of a acute level four social care plan. • Children living in families who have been discussed at Multi Agency Referral Action Conferences (MARAC) due to domestic abuse. Data collection and base-lining for these groups is still in its infancy. Children’s centres also carry out team around the family assessments. Of all assessments undertaken 21% were carried out by Early Years Children's Centres. Rationale: Children’s Centres have a core purpose to serve the needs of the 18,318 children (aged 0 to four years, 2012 census estimates) their families and pregnant women. They have a statutory duty to provide a service delivery hub for early education, family support and child and family health services. They also target need to those living in the most deprived areas. 20 Children's Centres (Part two) Cheshire West and Chester Joint Strategic Needs Assessment Challenges • Developing an understanding of performance data within the Children’s Centre teams. The introduction of the Performance and Support team in April 2014 to support Integrated Early Support (IES) Managers and their Children’s Centre teams in having a greater understanding of their centres performance. They will also offer challenge and scrutiny of Children’s Centre data via the introduction of monthly performance targets. • Developing partner agencies understanding of the importance of data sharing, not only for the use by Children’s Centres but also to their home organisations performance. • Ensuring all children’s workforce including health and social care partners, routinely register families with Children’s Centre provision and actively support families to access services, particularly families who are hard to reach. • Maintaining the appropriate balance of services to ensure that the Children’s Centre nine months to five years offer isn’t lost within the broader 0 to19 agenda of Integrated Early Support. • Full engagement of the team around the family assessment. • The timeliness of data collecting and inputting due to the range of organisations delivering services. Recommended actions • There is a need for improved data sharing with partners for an increased understanding of the importance of partnership working within Children’s Centres. Birth data is imperative to this. • Explore the potential for increasing the quota of DCLG funding allocated to Children’s Centres to enable a more robust delivery model for targeted early years service provision in order to meet the core offer of school readiness. • Develop a joint working approach and a single recording process to track the development of children through early years from two year health visiting assessments, early years entitlement tracking and foundation stage profile data. To ensure there is a single system to track children’s progress and measure outcomes. • Develop a joined up strategy and delivery model to address childhood obesity and breastfeeding by implementing a shared approach across all partners with data sharing and evidence based programmes. • Robust approach to ensuring partner organisations understand their role in data collection. • Continued training and support to the roll out of the performance management element of Integrated Early Support. • Identify and implement a suitable new Children’s Centre data base in order to support data collection and provide more accurate performance reporting for Children’s Centres. Rationale: Children’s Centres have a crucial role to play in ensuring that early support is provided to children and families via the Healthy Child Programme. Getting this right can affect the child’s physical and mental health and wellbeing, their readiness to learn, and their ability to thrive later in life. 21 Team around the Family (TAF) Cheshire West and Chester Joint Strategic Needs Assessment The Team Around the Family (TAF) is the Cheshire West and Chester approach to conducting an early assessment of a family’s additional needs and deciding how those needs are best met by Early Support Services through a robust multi agency plan. TAF focuses on interventions primarily at levels two and three of the continuum of need. All practitioners working with children across the borough are encouraged to initiate a TAF (completing a TAF form) where there are concerns which meet level two and three on the continuum of need. This reduces the demand on level four services and ensures the delivery of a more effective early support service to children and their families. Continuum of Need Over the past two years since TAF was launched, over 1500 practitioners have attended TAF multi agency workshops. Number of TAFs completed in year (2011/12 called Common Assessment Framework (CAFs)) 2011/12 2012/13 2013/14 646 881 (+36%) 932 (+5%) Since TAF was introduced in 2012 over 450 children have been stepped down by social care to receive level two or three intervention through TAF. At point of closing TAFs there has been a steady increase in the number closed where all the child’s needs have been met or where there is no need for multi agency involvement. In 2013/14, 480 TAFs (53% of all TAFs closed in the period) were closures as a result of all needs being met. This is an increase of 60 TAFs compared to 2012/13. Challenges • The development of the eTAF system ensures that all assessments and plans conducted within the Integrated Early Support Service (IES) are reviewed and authorised by Integrated Early Support Managers. For agencies outside of IES this is still a challenge. However, as the eTAF system develops and more outside agencies are trained in accessing and using the system this will become less of a challenge. • There is a rolling programme of case file audits, within which a TAF will be audited as part of the process. This, it is hoped will identify training gaps. A package of training for practitioners, along with support from the locality TAF cluster groups will continue in to the future. • Over the past three years, encouraging partners to come on board with the TAF process has been a challenge. Headline data shows this is progressing. • Receiving feedback from families and ensuring the individual’s voice is heard through all assessments has been a challenge. Recommended actions Since the introduction of TAF in early 2012 there has been a steady • Gaining feedback is now a target for all TAF assessments and plans to increase in the number of TAF assessments completed. Data from ensure that the family’s voice (both children and adults) is heard throughout TAFs opened in 2013/14 shows that a 932 TAFs were opened from the TAF process and on closure. Appropriate feedback forms have been 19 different agencies across Cheshire West and Chester with Primary developed to support this process. Education and Integrated Early Support initiating the most TAFs. • Continue to provide a package of support for practitioners through TAF Level four acute services have been encouraged to consider a workshops and TAF cluster groups. transfer to a TAF plan when stepping families down. Rationale: TAF improves multi agency consultation and the sharing of information, ensures action plans are clear and coordinated, and that a lead person is agreed. It prevents the need for children and/or families to repeat their information, or undergo repetitive assessments and reduces duplication of help and/or conflicting advice being given. Practitioners are better placed, along with the child and the family, to agree action plans coordinated through TAF meetings 22 Children and families complex cases (Level three) Cheshire West and Chester Joint Strategic Needs Assessment Cheshire West and Chester Council’s Early Support Access Team (ESAT) is a multi-agency team providing practitioners with a first point of contact for complex level three cases. Around 400 individuals per month (over 120 cases) are supported or provided with a service each month by ESAT. The police are the main source of contacts to ESAT (a trend reflected nationally) followed by schools and children’s services. Domestic abuse remains the main feature of concern of contacts to ESAT, making up nearly half of the total number of cases processed. The majority of open cases with domestic abuse as the main concern were in Northwich and Winsford locality and Chester locality. Abuse or neglect is the most common primary need at first assessment nationally. NUMBER OF NEW CONTACTS RECEIVED BY ESAT (2014) ESAT (individuals) Evidence of what works ESAT (children) • Having a multi-agency front door (ESAT) as a single point of contact has resulted in a reduction of people’s problems escalating to crisis point (to Children in Need (CIN) cases at Level four statutory/ acute), an increase in families identified for the targeted Troubled Families programme, and practitioners have reported the efficiency of the system allowing for better decision making. • Ensure the Early Support Access Team is able to easily identify families at the first point of contact. Continue to achieve sustained outcomes for families in the existing programme and become an early adopter of the expanded troubled families programme 2015-2020. To work with the Department of Work and Pensions and Job Centre to improve the employability of troubled families with a focus on making them job ready. Explore potential work around producing detailed information on troubled families in terms of health and links to employment. 800 700 600 483 500 Recommended actions 400 243 300 • 200 • SEPT AUG JULY JUNE APR MAY MAR FEB JAN 0 DEC 100 • Rationale: Families with complex needs experience significant disadvantage, including poor outcomes and life chances, often across generations. They are at risk of further polarisation and a disconnection from social and economic engagement. They can also disrupt quality of 23 life for others in their neighbourhood and place expensive demands on public services. Troubled families Cheshire West and Chester Joint Strategic Needs Assessment Troubled families are defined as those where parents are; out of work, children are not in school, and family members are involved in anti-social behaviour and crime. These families often face a range of other problems, such as poor physical and mental health, domestic violence and substance misuse. Nationally, children from troubled families are eight times more likely to be suspended or excluded from school than other children, and ten times more likely to be in trouble with the police. In Cheshire West and Chester, the troubled families programme was launched in 2012 and is a multi-agency whole family intervention programme for families who meet three of four of the following criteria: • Are involved in youth crime or anti-social behaviour (ASB) • Have children who are regularly truanting or not in school • Have an adult on out of work benefits • Cause high costs to the taxpayer/ under local authority discretion Of 529 families initially identified to take part in the programme, 197 resided in Northwich/Winsford locality, 157 in Ellesmere Port locality, 149 in Chester locality and 26 in Rural locality. The cohort showed a correlation between troubled families and concentrations of deprivation, with clusters of troubled families residing in the 30% most deprived small areas nationally. Prevalent wards in Northwich/ Winsford locality included Witton and Rudheath, Winnington and Castle, Winsford Swanlow and Dene, Winsford Wharton and Davenham and Moulton; in Ellesmere Port locality Ellesmere Port Town, Grange Rossmore and St Paul’s; in Chester locality Blacon, Lache and Newton. Children and young people in the cohort achieved significantly lower outcomes in education at key stage one and two than their peers in reading, writing and maths. There are currently 541 families, 2,010 individuals, engaged in the troubled families programme. Of these families, 95% (512) meet the criteria of worklessness, 56% (302) youth crime/ASB, 52% (279) education criteria and 74% (399) meet other local criteria. As of August 2014, 63% of families had been successfully 'turned around'. Evidence of what works Focus on the troubled families programme: • The success of the troubled families programme in Cheshire West and Chester and nationally demonstrates the effectiveness of multi-agency targeted family intervention. Locally a greater number of families are being turned around than projected (August 2014 projected 60 actual 111). • From May 2014, the Early Support Access Team began to make referrals to the troubled families programme. This resulted in a greater number of families engaged and a 20% increase in outcomes being achieved highlighting the importance of referral at the first point of contact. • Outcomes in employment and supporting people back into work are below those expected highlighting the difficulty of getting complex families job ready. Recommended actions • • • • Ensure the Early Support Access team is able to easily identify families at the first point of contact. Continue to achieve sustained outcomes for families in the existing programme and become an early adopter of the expanded troubled families programme 2015-2020. To work with the Department of Work and Pensions and Job Centre to improve the employability of troubled families with a focus on making them job ready. Explore potential work around producing detailed information on troubled families, in terms of health and links to employment. Rationale: Families with complex needs experience significant disadvantage including; poor outcomes and life chances often across generations. They are at risk of further polarisation and a disconnection from social and economic engagement. They can also disrupt quality of life for others in their neighbourhoods and place expensive demands on public services. 24 Children in need Cheshire West and Chester Joint Strategic Needs Assessment Numbers of children in need at 31 March 2013 by primary need at initial assessment N1 Abuse or neglect 1,047 Child's disability or illness 236 Parent's disability or illness 14 Family in acute stress 186 N5 Family dysfunction 408 N6 Socially unacceptable behaviour 19 N9 Cases other than children in need 0 N0 Not stated Source: Department for Education, 2013 15 0 At 31 March 2013, there were 1,939 children in need in Cheshire West and Chester. This is a rate of 293.90 per 10,000 (2013), an increase from the 2012 rate of 270 per 10,000. Since 2013, Children in need referrals to Children’s Social Care showed a decline and remain below the North West and England averages. There is also a decrease in the number of referrals in which a previous referral has taken place. Children aged between five and nine years have the highest number of referrals. The main factors identified at assessment relate to abuse or neglect, family dysfunction and the child’s disability or illness. At 31 March 2013, 313 children in need had a disability, a rate of 16.1 per 10,000. 48% were reported as having learning difficulties, 29% with Autism or Asperger’s Syndrome and 21% had communication issues. 36.5% of children in need had been an open case for two years or over. 1,907 children ceased to be in need in the year ending 31 March 2013. In 85% of these cases the child was deemed no longer in need and 54% had been an open case for three months or less. Evidence of what works • The implementation of the revised continuum of need threshold document has led to clearer multi-agency understanding. • Robust monitoring and referrals are sign posted to appropriate agency/level. • Greater emphasis upon prevention and early intervention and the way we work with children and families and partner agencies. • Specialist support for children and young people including options for therapy. Support for perpetrators focusing on learned behaviours and working to change them. 200 400 600 800 1000 1200 Number of children in need Age band of children referred to Social Care (June 2014) 2% 10% 8% Unborn Under 1 25% 27% 1 to 4 5 to 9 10 to 15 16 plus 28% Recommended actions • Monitor and evaluate the targeted commissioned services in respect of domestic violence, alcohol and mental health and outcomes improved for children and families. • Progress the edge of care project which is a more integrated, targeted and responsive model for those on the ‘edge of care’ where family breakdown is imminent. • Further development with teenagers around healthy relationships and the signs of domestic abuse. Rationale: A child in need is one who has been assessed by children’s social care to be in need of services. Providing support can help keep families experiencing difficulties together and target interventions to prevent children going into care. 25 Children on child protection plans Cheshire West and Chester Joint Strategic Needs Assessment Cheshire West and Chester has a lower rate of children with a Child Protection Plan (32.10 per 10,000 children) compared to England (37.90 per 10,000) and statistical neighbours (39.36) (at 31 March 2013). A total of 227 children became the subject of a child protection plans during 20122013. Trends from 2012 to 2014 have shown a decline in numbers from 266 in September 2012 to 180 in June 2013, after which the average per month has remained between 166 and 182. As of June 2014, there were 201 cases held; 14 cases held by the Children with Disabilities team, 62 by Chester Family Support and Children in Need, 72 by Ellesmere Port Family Support and Children in Need and 53 by Northwich and Winsford Family Support and Children in Need. Child protection by age range at 30 June 2014 3% 3% Source: Department for Education 9% Unborn Under 1 26% 1 to 4 29% 5 to 9 10 to 15 16 plus 29% Child protection by category of abuse at 30 June 2014 6% Emotional abuse and neglect are the most prevalent reasons for children and young people to be made the subject of a child protection plan in Cheshire West and Chester and nationally. Evidence of what works • Smarter plans, timely intervention and robust monitoring over the length of child protection plan. • Good multi-agency engagement within conferences and core groups. • Having a multi-agency front door (ESAT) as a single point of contact has resulted in a reduction of people’s problems escalating to crisis point. 33.5% of children were subject to the plan for more than six months but less than one year, 25.5% for Recommended actions one year but less than two years, 21.2% for three Neglect • Monitor and evaluate commissioned months or less, 17% for more than three months or services. Physical abuse up to six months, and 2.8% for two years and over. • Audit of Children In Need cases to 262 children ceased to be the subject of a child ensure escalation to Child Protection is protection plan during 2012-13, a rate of 39.7 per Sexual abuse appropriate and timely. 10,000 children. This is lower than the England rate of 45.7 per 10,000 children. Emotional abuse 10% 25% Analysis of 2012/13 cases shows that over half of all child protection plans were for children aged under five. 71% of child protection plans for physical abuse were for children under five, 56% of plans for neglect were for children under five and 50% of plans for emotional abuse were for children under five. 58% Rationale: Children considered to be in need of services are discussed at a multi-agency Child Protection Conference. If the child is considered to be at continuing risk of significant harm he or she will be subject to a Child Protection Plan. Inter-agency interventions will be put in place to safeguard the 26 child. Children in care Cheshire West and Chester Joint Strategic Needs Assessment Source: Department for Education As of 31 March 2013 there were 385 children in care in Cheshire West and Chester; this is a rate of 58 per 10,000 children under 18, similar to the England rate of 60 per 10,000 children under 18. Data for 2014 indicates that numbers have continue to increase in 2014. The majority of looked after children (40%) are aged 10 to 15 years and 24% are aged five to nine. There is a similar split between males and females and 97% of those in care in Cheshire West and Chester are white British. Age of looked after child at 31 March 2013 5% 16% 15% Under 1 1 to 4 5 to 9 24% 40% 10 to 15 16 and over Children in care are categorised according to the legal status under which they have been placed. 2013/14 data shows that 45% of children in care in Cheshire West and Chester had a full care order, slightly higher than the national figure of 42%. The next largest category was Interim Care Order which was 24%. This was higher than the national figure of 17%. 18% of children in care were accommodated under Section 20 which was lower than the national figure of 27%. 10% had a placement order which was lower than the national figure of 14%. Two thirds of children in care 68%, were in care because of abuse or neglect, this was higher than the national figure of 56%. This was followed by family dysfunction (16%) and families in acute stress (11%). These figures compare favourably with the overall England average. The majority of children were in foster placements with other placements including secure units, children's homes and hostels. RATIONALE: A child who is being looked after by the local authority is known as a child in care or "looked after". Some children are placed in care voluntarily by parents struggling to cope. In other cases children's services will have intervened because a child was at risk of significant harm (NSPCC) 27 Children in Care: Demand Cheshire West and Chester Joint Strategic Needs Assessment CHILDREN IN CARE NUMBERS OVER 24 MONTHS 500 480 476 460 440 Evidence of what works • Children in care thresholds are appropriate and responding to them accordingly. • Planning for permanency, avoiding any drift and supported by the 26 week court timetable. 420 400 380 360 340 320 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 300 In Cheshire West and Chester, over the past four years, the rate of increase in the total numbers of children in care is higher than that of the England and North West averages. The total number of children in care per 10,000 of the population is higher than the England and statistical neighbour averages, although lower than the North West averages. There are consistently more joiners than leavers to care each month. The increasing demand for placements has resulted in an increase in the proportion of children placed more than 20 miles from their home and outside of Cheshire West and Chester boundary. There are slightly more males than females in care. 51 children in care have a disability, of which 45% have a learning disability, autism or Asperger's. Recommended actions • Children in care joiners continue to be higher than the number leaving care. A thematic audit is to be carried out to analyse the journey of children in care joiners with focus on what early support is needed. • Progress ‘edge of care’ project which focuses on preventing children on the edge of care from going into care. • Place greater emphasis on exit planning. • Analyse the children with disabilities cohort (percentage of autistic children). • Continue the fostering and adoption recruitment campaign. Number of looked after children 390 380 370 360 350 340 330 320 310 385 365 355 335 31 March 2010 31 March 2011 31 March 2012 31 March 2013 RATIONALE: The increasing demand for care placements for looked after children has resulted in an increase in the proportion of children placed outside of the Cheshire West and Chester boundary which can result in disruption for the child in terms of schooling and socialising. 28 Children in Care: Placements Cheshire West and Chester Joint Strategic Needs Assessment Evidence of what works • Foster carers receiving specialist support and training. • All foster carers supported by an experienced family placement social worker. • Increased sufficiency through targeted recruitment and evidence base of looked after population needs. Recommended actions • The Edge of Care project focusing on preventing those on the edge of care going into care. • In house recruitment strategy to continue. • Plans to open a second and third residential establishment for looked after children. The percentage of children in care with three or more placements in Cheshire West and Chester has declined since 2010 to present, despite seeing an increase between 2012 and 2013. The rate of children under 16 years, in care for more than two and a half years and in the same placement for more than two years has declined since 2011, although data from March 2014 indicates that the rate has increased but remains lower than the England and Statistical Neighbour averages. The percentage of children placed % of placements in and out of local authority Placements at 31 March 2013 outside of the local authority boundary boundary at June 2014 and no more than 20 miles from home Foster placement 76% has increased from 14.7% to 20.2% between July 2012 and June 2014 and Secure unit 9% is higher than the England and Placed for adoption 5% statistical neighbour averages. Placed with parents 4% Residential school 4% Other placement in community 2% 0% 20% 40% 60% 80% 100% At 31 March 2013, the majority of children in care are in Cheshire West and Chester Council local authority provision, 125 are in private provision. Of 495 children in care 50 were in short term placements. Outside 43% Inside 57% Rationale: UK wide policy for looked after children has concentrated on increasing the stability and quality of placements offered . The Rowntree Foundation found that those in stable placements are more likely to; succeed educationally, be in work, and manage accommodation after leaving care. 29 Health needs of children in care Cheshire West and Chester Joint Strategic Needs Assessment The table below shows the health outcome data for Cheshire West and Chester children in care in comparison with the national data as of March 31st 2013. Number of children Number of children with health Number of children Number of children who have had their surveillance checks immunisations up to with teeth checked annual health Processing year up to date date by a dentist assessment 2013 30 228 237 252 Cohort 44 264 264 264 CWAC % 68% 86% 90% 95% 2011/12 England 80% 83% 82% 86% average 2011/12 statistical 79% 81% 73% 78% neighbour average Below English Below English Below English Below English average average average average CWAC relative Below statistical Below statistical Below statistical Below statistical performance neighbour average neighbour average neighbour average neighbour average Source: Department for Education Historically the health outcome data has provided a snapshot of the health of Cheshire West and Chester children in care but it has been recognised that there is a wealth of information that could be captured from the children’s health assessments. The health data collection tool was developed in collaboration between health and social care. Health data has been collected for children who have had a health assessment from October 2013. It is important to note that this is a new process and not all children who have been looked after continuously for 12 months as of 31 March 2013 will have had a health assessment at this time. However, the following information obtained from the data collected does provide an insight into the health of children in care in Cheshire West and Chester. Around 10% of the children were not up to date with immunisations (n=26). This compares favourably with the percentage of Cheshire West and Chester children who were up to date with their immunisations in 2013. The predominant problem for children over the age of 15 years living in care was lifestyle issues. The most common being smoking (n=24) and alcohol (n=10). Type of Aged 0-4 Aged 5-9 Aged 10-14 Aged 15-18 Aged 0-18 Diagnosis Count Rank Count Rank Count Rank Count Rank Count Rank EMOTION 3 9 17 1 25 1 25 1 70 1 VISION 7 3 12 2 10 2 16 2 45 2 ECZEMA 13 1 10 3 8 4 4 7 35 3 DEVDELAY 7 3 9 4 7 5 8 4 31 4 SPEECH 12 2 6 5 3 10 3 13 24 5 Source: Cheshire West & Chester Council, Cheshire & Wirral NHS Partnership The most common health referral was to ophthalmology followed by child and adolescent mental health services (CAMHS). CAMHS referrals were more prevalent in children aged over 15 years. The total number of children for whom this data was collected was 279. Of these 89 had at least one ongoing health referral the most common being community paediatrics followed by speech and language therapy and other hospital specialists. Children who have a physical or learning disability have an average of three ongoing referrals whereas there was an average of 0.5 referrals overall as of March 31 2013. The most common health diagnosis for children in care aged over five years was emotional, behavioural and mental health issues. This was followed by speech and language delay. For children aged under five years, eczema was the most common diagnosis followed by vision problems. Rationale: In England all looked after children are required to have regular health assessments to ensure their health needs are being met and they are not missing out on routine preventative health care, such as immunisations. These health assessments are an opportunity to identify unmet health 30 needs and actively promote health in its widest sense. Adoption Cheshire West and Chester Joint Strategic Needs Assessment • • • • Evidence of what works The increased recruitment and assessment of adopters to provide more choice for children. Support offered to adopters to ensure fewer breakdowns of placements. Ensure staff are fully trained. Increasing the numbers of foster carers opens up the routes to adoption for children looked after. Recommended actions • Continuation of recruitment strategy targeted to need. • The DFE grant funded support programmes to ensure more appropriately trained staff. The percentage of children in care who are adopted has been increasing since 2011. 15 children were adopted in Cheshire West and Chester in 2013. This is lower than 2012, but numbers for 2014 currently indicate an increase. The average number of days a child was looked after before moving in with their adoptive family (based on a three year average for 2010-13) is 538. This is below the England and statistical neighbour average. In 2014, 29 children were living with their prospective adoptive families and awaiting the adoption order to be made. Another 20 children were in the process of family finding. Cheshire West and Chester 1000 900 800 700 600 Other NW LAs England Av 647 538 552 561 562 612 628 638 654 658 689 700 701 709 719 731 744 771 786 791 828 842 885 2013 15 650 36.5 3980 538 Number of looked after children adopted in year 2010 2011 2012 Local authority, region and England Cheshire West and Chester 10 10 20 North West 550 520 590 Statistical neighbours 18.5 19.4 21.5 England 3200 3090 3470 Chart showing The average time between a child entering care and moving in with its adoptive family, for children who have been adopted between 2010-2013 500 400 300 200 100 0 Rationale: The local authority has a responsibility to engage the looked after child's birth parents and wider family in identifying solutions for care and placement options. When these have been explored but no options identified then fostering for adoption may apply. 31 Domestic abuse affecting children and young people Cheshire West and Chester Joint Strategic Needs Assessment There are an estimated 6,350 victims of domestic abuse in Cheshire West Young people discussed at MARAC and Chester. Not all will be visible to services, around 400- 440 high risk during October 2013 – June 2014 victims and 360-400 medium risk will be at, or near, the point of help seeking. Victims aged 16 to17 In 2013/14, there were 1,141 recorded incidents of domestic violence. Cheshire Police report that around 40% of incidents arise as a result of Cases where victims aged 16 to 17 alcohol abuse and that domestic abuse accounts for around a third (38%) of Number harming others aged 17 or below all assaults with injury in Cheshire and eight percent of all recorded crime. West Cheshire National figure 16 946 5% 2% 4 472 Around two thirds of adult victims have approximately two children each implying there are over 1,000 children living in high and medium risk households. Half of these children and young people will be visible to services. High risk domestic abuse cases are discussed at Multi-Agency Risk Assessment Conferences (MARACs). There were 458 cases discussed at MARAC in Cheshire West and Chester (July 2013-14) relating to 349 individuals. Approximately five percent of MARAC cases are for victims aged 16 to 17. Cheshire West and Chester’s Early Support Access Team (ESAT) is a resource for practitioners who are dealing with families with children and vulnerable adults where there is domestic abuse. In 2013/14, there were 526 contacts to ESAT where domestic abuse was the main reason for contact. If risk assessments indicate that any children within the home is at risk of significant harm, as a result of domestic abuse then a referral is made to Children’s Social Care. The number of children in need in Cheshire West and Chester’s Children’s Social Care services (at March 2013) was 1,944 and an estimated 40% had domestic abuse as a primary factor. The average percent of Child Protection Conferences where domestic abuse was identified as a parental factor was 40% (victim) and 33% (perpetrators). Of those in care, two thirds have a category of abuse or neglect. The Cheshire West Domestic Abuse Family Support Unit (DAFSU) works with victims of abuse, aged 16 and over, who are considered high risk cases. In 2013/14 there were 443 high risks cases referred to the DAFSU. Data for victims aged 16-17 was collected for five months during 2013/14 this showed that 3.7% of cases referred were in this age group. In 2013/14, the DAFSU worked with the parents of 562 children affected by domestic abuse; the majority aged 0 to five years. National research indicates that around 62% of young people exposed to domestic abuse are directly harmed. The DAFSU in 2013/14 collected data for five months on the number of children and young people aged 17 and under who caused harm. Of all perpetrators, three percent were aged 17 and under. Evidence of what works • • • • Multi-Agency Risk Assessment Conferences (MARACs) - multiagency meetings focused on increasing the safety of high risk victims and their children by sharing information and developing a risk management plan. Promoted nationally as a best practice response to domestic abuse. Use of the Co-ordinated Action Against Domestic Abuse (CAADA) Stalking and Harassment Risk Identification Checklist (DASH RIC) assessment – ensures a consistent approach is applied in identifying and assessing risk. Taking a holistic approach – tackling not only the effects of domestic abuse but also its causes. Agencies working together to engage, support and work with victims and perpetrators are more likely to achieve positive results. Recommended actions • • • • • Publicity - promotional and educational information must be more widely available and publicity materials should be made accessible including Braille, different language and easy-read versions. Domestic abuse training should be undertaken on a regular basis to inform and support professionals and front line workers across the borough. Peoples needs, perceptions and circumstances differ among ethnic minority communities, older people, those who identify as lesbian, gay, bisexual or transgender and people with a disability. This must be taken into account. A pilot prevention programme for young perpetrators focusing on learned behaviours and working to change them. All organisations work together to increase formal and informal networking opportunities for practitioners to improve working relationships. Rationale: Domestic abuse is an underreported crime with significant impact on the lives of victims, children and the wider community. The impacts are significant and longstanding. Domestic abuse presents a number of overlapping issues including links to mental health, physical and learning 32 disabilities, housing, crime, anti-social behaviour, drug and alcohol misuse and safeguarding (Cheshire West Domestic Abuse Strategy) Young people age 13-19 years healthy relationships and disclosure of domestic abuse Cheshire West and Chester Joint Strategic Needs Assessment Types of abuse experienced by young people in England Emotional abuse Jealous/controlling Harrassment/stalking Physical abuse Financial abuse Sexual abuse Neglect Source: CAADA, 2014 0% What is an abusive relationship Relationship abuse between young people refers to relationships where the young people have been, or are in, an intimate relationship. This includes long term relationships and more casual or one-off encounters. If a young person is 16 or over and has suffered one or more incidents of controlling or threatening behaviour or assault by a boy/girlfriend, then they can be classed as a victim of domestic violence. Domestically abusive behaviours can take the form of physical, sexual, emotional and/or financial abuse, amongst other forms. Evidence shows that coercive and controlling behaviours are likely to escalate into violence and subsequently become a reoccurring feature in the relationship. 72% 69% 55% 55% 21% 19% 13% 50% 100% Research by the NSPCC found that 33% of girls and 16% of boys reported some form of sexual abuse, 25% of girls and 18% of boys reported some form of physical abuse and 75% of girls and 50% of boys reported some form of emotional abuse. Those aged 13 to 15 were as likely as those aged 16 and over to experience some forms of relationship abuse. Nationally, of young people referred to Co-ordinated Action Against Domestic Abuse (CAADA), 83% were referred because of intimate partner violence in their relationship. The most common type of abuse was emotional abuse and jealous and controlling behaviour. However, many experience multiple types of abuse. The young people supported are extremely vulnerable and are at high risk of serious harm. The majority supported reported depression or anxiety, and more than a third had self harmed. Many do not live in a safe environment and are from ‘troubled families’. Teenage relationship abuse is often hidden due a number factors including having limited experience of relationships; being under pressure from their peers to act a certain way; and accepting violence in the relationship. One in five young men and one in 10 young women think abuse or violence against women is acceptable. The NSPCC found that the majority of young people did not inform an adult of the abuse. The young person can also experience a feeling of entrapment. Experience of abuse can have serious outcomes including substance misuse, depression, self-harm and suicide. Recommended actions • • • • • • • • • Begin to collate local data relating to young people and domestic. Consult young people in Cheshire West and Chester secondary schools and youth provisions on ‘healthy relationships’, to identify gaps in knowledge of healthy and abusive relationships. Use consultation findings to inform practice and the Cheshire West Domestic Abuse Strategy 2014/16. Deliver ‘train the trainer’ domestic abuse training to professionals working with 13 to 19 year olds, to improve early identification and ensure they have the skills, knowledge and competency to inform, educate and support young people experiencing, or at risk of, domestic abuse. Peer educators to provide educational workshops in informal and educational settings, for both boys and girls, to inform and raise awareness of unhealthy and abusive relationships. Ensure young people have access to young person friendly information and guidance packs on the signs of unhealthy and abusive relationships, safety planning and what support is available to them. Agree a care/referral pathway for disclosures for 13 to 19 year olds and professionals at a local level through Early Support Access Team (ESAT), Children’s Social Care and Multi-Agency Risk Assessment Conferences (MARAC). Deliver bespoke training to external professionals and workforce who support 1319 year olds on care/referral pathways and young peoples Coordinated Action Against Domestic Abuse (CAADA) Risk Indicator Assessment (RIC) /MARAC, including youth charities, youth service, Princes Trust and YMCA Training. Relevant Practitioners becoming involved with data collection with CAADA toolkit. Rationale: A healthy relationship is based on a caring and respect. Young people who experience abuse within an intimate relationship are extremely vulnerable and at risk of harm to their mental and physical health along with an increased likeliness of substance misuse and sexually risk-taking behaviour. 33 Child sexual exploitation Cheshire West and Chester Joint Strategic Needs Assessment What is child sexual exploitation? Child sexual exploitation (CSE) is a form of child abuse affecting children and young people under the age of 18. The nationally agreed definition of CSE from the Department for Children, Schools and Families (DCSF) is that it ‘involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, attention, gifts, money) as a result of them performing, or others performing on them, sexual acts or activities’. The young person may have been groomed (when someone builds a relationship with a child to gain their trust), and believe they are in a loving consensual relationship with the perpetrator. Grooming can take place online or in the real world by a stranger or someone they know. Sexual exploitation can occur online or by telephone and does not require physical contact. Once trust and power is gained the ‘relationship’ may involve violence and intimidation to continue to exploit the young person. The young person often does not report the abuse due to feelings of shame, fear of harm to themselves or others, fear that they will not be believed, not wanting to give something up e.g. drugs or gifts, or because they are manipulated into thinking that they want to remain in the relationship and have loyalties to the perpetrator. Who is most at risk of CSE? Child sexual exploitation can happen to any child or young person. However, some may be more vulnerable as shown in the diagram. Some of these factors can also be signs of CSE taking place and are cause for concern. Children under the influence of substances are at increased risk due to a lack of control and putting themselves in risky situations to access drugs and alcohol. Certain groups are more susceptible to using substances including those experiencing abuse and neglect, children living in care or having left care, those who are missing from home and care, those with mental health issues and those disengaged from education. Key signs of CSE • Absence from school • Missing from home / care • Drug and / or alcohol use • Involvement in crime • Change in physical appearance • Physical injuries • Shows sexualised behaviour (inappropriate sexual behaviour for their age) • Treated for sexually transmitted infections • Treated for pregnancy and terminations • Thoughts or attempts of suicide and self-harm • Older boyfriend/girlfriend • Tired in school • Unknown friends on social networking sites • Mental health issues including depression • Secretive phone calls and internet use • Unknown vehicles dropping them off • Arguments at home with their families • Behaving differently • Appears frightened of a particular person • Have new things that they can’t explain (From Pan Cheshire website ‘Know and See’ and NSPCC) Rationale: Child sexual exploitation has a serious lasting impact on every aspect of a child and young person’s life including their physical and mental health, education, personal safety, relationships and future life opportunities. Those targeted are often those most vulnerable. 34 Child sexual exploitation Cheshire West and Chester Joint Strategic Needs Assessment Between March 2014-March 2015, there were 52 children and young people in Cheshire West and Chester assessed as being at risk of child sexual exploitation (CSE) by the Cheshire West and Chester CSE operational group. All children were aged 12 to 17 years and the majority were girls. 11 were children in care. Two in five cases were considered high risk and investigated by Cheshire Police. Difficulties faced by victims of CSE can include: • Isolation from family and friends • Teenage parenthood • Failing examinations or dropping out of education altogether • Unemployment • Mental health problems • Suicide attempts and self harm • Alcohol and drug addiction • Aggressive behaviour • Criminal activity Between 2013-14, all suspects in CSE cases were male except for one female. In just under half of cases investigated, the investigation was raised in response to concerns about young people who had been CSE also has long term impacts on the whole family with parents/carers reported missing to the police. feeling anger, guilt, shame and confusion. This can lead to strain on relationships with parent and child expressing symptoms of poor mental There are strong links between children and young people who go health. Siblings may become remote not fully understanding the situation. missing and CSE. Between 2013-14, there were 299 missing child Evidence of What Works notifications received by the organisation Catch 22, the Cheshire West • Multi-agency working and Chester commissioned service that supports children and young • An approach, strategy and protocol for dealing with and tackling CSE people who have been missing from home or care. The missing • Raising awareness of CSE with organisations, those who work with notifications involved 155 children, indicating repeat missing episodes or encounter children and young people and parents by the same child is significant. The link between CSE and children • Raising awareness with children and young people about the risks going missing is strong, with some forced to stay in harmful that can lead to CSE such as losing control when under the influence of drugs and / or alcohol environments and engaging in risky activities such as using drugs and alcohol. Children missing from home in Cheshire West and Chester gave socialising and boredom as the main reasons for going missing Actions undertaken in Cheshire West followed by family conflict. For children going missing from care, the • County wide multi-agency CSE sub group and CSE operational most common reasons were a placement issue of a contact issue. group setup by the Local Safeguarding Children Board (LSCB) • Have a CSE strategy and multi-agency operating protocol, a lead person to co-ordinate a multi-agency response and multi-agency There are different types of CSE including single perpetrator, and support for victims and families during court cases multiple perpetrator CSE which includes group-associated, gang associated and within a gang or group. Not exclusively, but the type of • Represented on Pan Cheshire CSE Strategic Group • Commissioned Catch 22 to support young people notified as missing CSE evident in Cheshire West and Chester is predominately against a from home or care including conducting return interviews single child with one male perpetrator with whom the child feels they • Multi-agency audit on sexualised behaviour to scrutinise approach are in a legitimate relationship. There are a number of repeat • CSE screening tool kit developed and used by local practitioners to perpetrators responsible for the exploitation of more than one child. assess a young persons vulnerability to CSE • Devised a one minute guide to help to identify potential signs of CSE Areas of interest to Police in Cheshire West and Chester or • Delivery of a safer schools conference and roll out of guidance on how to support children and manage risks particularly around considered ‘hotspots’ include licensed premises suspected of selling sexualised behaviour alcohol and cigarettes to underage children, places children are known • ‘Risking it all’ performance and workshops with year 10 pupils to to frequent when skipping school and locations identified as meeting raise awareness of CSE places of children at risk. • Development of dedicated CSE website called ‘Know and See’. Rationale: Child sexual exploitation has links to others types of crime including child trafficking, domestic abuse, abusive images of children and their distribution, sexual violence, drugs-related offences, gang-related activity, immigration-related offences, grooming and domestic servitude 35 Young people’s issues Cheshire West and Chester Joint Strategic Needs Assessment Cheshire West and Chester delivers the United Kingdom Youth Parliament (UKYP) elections in February bi-annually. During this process the young people are asked about issues that affect them in their daily lives. Many of these issues are fed into local, regional and national government. The issues are also split into area reports allowing the issues to be addressed in our youth clubs where young people work with qualified staff to address the issues, explore their fears and gain information. This allows them to make informed choices in their lives. Issues identified by young people at the 2014 UKYP election Transport issues Employment 15% 16% Personal safety (inc on-line safety) Leisure provision 6% 14% This information is taken from Cheshire West and Chester integrated youth support service recording system which highlights issues covered during youth club sessions. It ensures that issues identified by young people are being addressed and that help and support is provided. Youth clubs respond to the needs of young people on a daily basis giving young people the information they need to make informed decisions. Drug and alcohol issues More youth provision 7% Environment 7% 9% 8% 9% Safe streets/ policing 16 to 19 bursary 9% Other Evidence of What Works Consulting with young people about youth club programmes enables them to take ownership of their environment, build respect within the club, and gives young people an opportunity to address sensitive issues. Recommend actions • Continue to be proactive and reactive to the issues young people face. • Continue to consult with young people on areas they require help and support. • Enable young people to use their learning to enhance their future development. • Support young people in evaluating the impact of youth work upon their own development. • Ensure staff have relevant area data to address local issues raised. Rationale: Children and young people should be empowered to inform decisions and have their voices heard both locally and nationally (UK Youth Parliament). 36