Children’s 0 to 5 JSNA (2022) - Publications

There are predicted increases in the number of under 5-year-olds in Warwickshire that needs to be accounted for in the commissioning of services. Some increases are in the immediate term, in particular a 2% year on year growth in numbers is predicted in South Warwickshire. Over the longer term there is a county wide increase in the number of under 5-year-olds by 17.7% in 2043.

There is an increasing ethnic diversity within Warwickshire’s children compared to Warwickshire’s population at the time of the last Census in 2011. The evidence is that there are differences in long term health outcomes by ethnicity, with most groups having worse outcomes than ‘White British’. Given the importance of the first 1,001 days to long term health, services need to ensure that ethnicity is being recorded to support with measuring outcomes by ethnicity at a local level.

Deprivation is often a marker for where more resource is needed to be targeted to achieve the same outcomes as more affluent areas. Relative levels of deprivation are increasing in Warwickshire, and there are higher levels of need in Nuneaton and Bedworth, Rugby town centre and Leamington. This is backed up by evidence that the largest numbers of children in low-income families from 2015/16 to 2018/19 has been in Nuneaton and Bedworth and Rugby.

Children in low-income families are associated with poorer outcomes in adult life, premature mortality, and lower life expectancy, as well as other health issues including mental health.

Within Warwickshire, Nuneaton and Bedworth has the highest number of 0-5 children in relatively low-income families, accounting for 19% of its total 0-5 population.

Deprivation is linked to performance at school and has been shown to have an adverse impact on school readiness. Out of the bottom 10 wards in Warwickshire for achieving a Good Level of Development, 4 of those contain Lower Layer Super Output Areas (LSOAs) in the top 30% most deprived.

All areas of Warwickshire have a low birth weight rate lower than the England average, however there are inequalities with Nuneaton and Warwick having the highest rates. This fits with the ethnicity profile of the population showing high proportions of mixed ethnic heritages in these areas, and the audit results showing that these groups are more likely to have low birth weight and premature births. Rugby is notable for having low rates despite diverse population.

Obesity during pregnancy increases risk of complications during pregnancy and childbirth. Warwickshire North CCG has higher rates of women with obesity in early pregnancy (25.3%) than the England average (22.1%). South Warwickshire CCG is significantly lower (17.6%). When comparing to LSOA deprivation, the most deprived LSOAs have the highest rates of obesity in early pregnancy (28.52%) and the least deprived have the lowest (15.07%).

Smoking in pregnancy results in increased risk of complications during labour and risk of miscarriage, premature birth, stillbirth, low birth weight, sudden unexpected death in infancy and infant mortality. Warwickshire North has the higher rates of women smoking in early pregnancy (15.88%) compared to the England average (12.76%). South Warwickshire is significantly lower (8.46%). When comparing to LSOA deprivation, the most deprived LSOAs have the highest rates (24.02%) and the least deprived have the lowest rates (4.3%).

Pregnancy with a low maternal age is high in the North, with Nuneaton and Bedworth (23.7 per 1,000) and North Warwickshire (18.1 per 1,000) both higher than the England average (15.7 per 1,000).

The Perinatal Mental Health Dashboard for Coventry and Warwickshire indicated that:

• 18.2% of the referrals are of women living in the most deprived decile.
• 8.1% of the caseload represented women aged 16-20 and 67% were women aged 26-39.
• 72% of the caseload where from white ethnic background, while 3.3% were of Asian descent and 2.5% were of black heritage.

Good quality antenatal or parenting education (PE) can empower families to make healthy choices and decisions about both pregnancy and the early years of an infant’s life. Data collected from parents participating in the midwife led virtual classes reported that 95% initiated skin-to-skin contact at birth and 82% initiated breastfeeding highlighting the value of PE.

However, this virtual offer only reached 5% of new parents in 2021. This low access figure combined with one of the trusts lacking a specialist PE midwife role identifies both a gap and inequality across the Warwickshire footprint.

Breastfeeding data is poor. Work is needed to improve definition and collection of this data. However, current indicators show that both South Warwickshire NHS Foundation Trust (81.8%) and University Hospitals Coventry and Warwickshire NHS Trust (73.8%) achieve a higher percentage of infants receiving breast milk at first feed than the National average (72.4%). A lack of data means we do not know rates for George Eliot Hospital NHS Trust at this time.

Warwickshire has less childhood obesity than England as a whole, but both North Warwickshire and Nuneaton and Bedworth have higher rates than the England average. There is also a large increase in children being very overweight in reception (8.6% of children being overweight) to year 6 (16.8%).

All Districts and Boroughs have a better rate of five-year-olds with experience of visually obvious tooth decay than the England average. The highest rates in Warwickshire are in Nuneaton and Bedworth (19.8% of children having visually obvious tooth decay).

There is a drop in vaccine coverage as children get older, most notably the uptake in children aged 5 for the 2nd dose of the MMR vaccine has a 89.6% uptake in 2020/21 compared to the 1st dose uptake for the same cohort of 96.1%. This means that some children had one vaccination but not their second, despite being eligible.

The Warwickshire Domestic Violence and Abuse Joint Strategic Needs Assessment provides evidence to suggest that pregnant women and women with children under the age of 5 are more likely to experience abuse and / or require support from agencies. The assessment included the following specific relevant recommendations:

• There are opportunities for all services/agencies that work with parents, infants, and young children to facilitate disclosures and signpost to appropriate support.
• There is a need to consider the support needs of a child under the age of 5 who has witnessed or experienced domestic abuse to recover from their experience and rebuild their relationship with the non-abusing parent. There is also a need to consider the support needs of the non-abusing parents to recover and move on from their experience.

A paucity in local data and intelligence to assess speech, language and communication needs in Warwickshire children means it has not been possible to accurately assess the local picture at this time.

However, the Local Authority Interactive Data tool indicates that Warwickshire scores low (10th out of 11) compared to statistical neighbours for the percentage of children achieving at least the expected level in the Foundation Stage Profile in 2018/19.

Hospital attendances dropped over the first Covid lockdown but have been recovering since the alpha wave. Successive waves of Covid haven’t impacted on this recovery.

North place has the highest number of attendances in terms of raw numbers.

Both rates for 0-5 A&E attendance and 0-5 Hospital admissions show higher rates for males then females.

Indices of Deprivation show that both rates for 0-5 A&E attendance and 0-5 Hospital admissions in the most deprived areas are most prevalent in North Place, whilst the least deprived areas are the most prevalent in South Place.

Ethnicity shows lower proportion of attendances from children with mixed ethnic heritage.

South Place particularly has seen increases in attendances following the second lockdown.

Rugby has the largest number of childhood injury admissions in Warwickshire, whilst Nuneaton and Bedworth has the lowest.

Unintentional injuries are a leading cause of hospitalisation and major cause of premature mortality for children aged 0-5, often resulting in long-term health issues. The majority of these injuries are preventable and working to prevent these injuries has significant long-term benefits for individuals, families, and society.

The emergency hospital admission rate for unintentional injuries nationally in the 0-5 age range is 38% higher if a child lives in one of the most deprived areas compared with those children who live in the least deprived.

For some injury types this inequality is larger, with children living in the most deprived areas at a 50% higher risk of being burned, scalded or poisoned and this resulting in primary or secondary care attendance, then for those living in the least deprived areas.

The highest rate per 10,000 for hospital admissions caused by unintentional and deliberate injuries in children aged 0-4 years in 2019/20 is in Rugby, which is higher than both the Warwickshire and England average.

The Reducing unintentional injuries in and around the home among children under five years paper advises that Local Authorities could achieve significant improvements through targeting the reduction of five causes of unintentional injuries among the under-fives. These are:

• Choking, suffocation and strangulation
• Falls
• Poisoning
• Burns and scalds
• Drowning

The largest categories for 0-5 death type are ‘chromosomal, genetic and congenital anomalies’, and ‘perinatal/neonatal event’ (including prematurity).

There is a relationship with infant mortality and the wider determinants of health, deprivation, and inequalities.

Infant mortality rates in Nuneaton and Bedworth, and Warwickshire North are higher than the national average, whilst Warwick and Stratford are below average.

Of the 122 Warwickshire Child Deaths between 2017 - 2021, 45 were cases over a month of age. Of the 45 cases just over a quarter (29%) identified modifiable factors. Out of the factors identified, smoking and unsafe sleeping contributed to over 50% of child deaths. Other factors include alcohol, drugs, consanguinity, maternal BMI, and booking a pregnancy late for services.

Neonatal mortality is defined as deaths within the first 28 days of life – excluding stillbirths. The highest rates are in Warwickshire North (4.1 per 1,000 births) for the 2017-19 reporting period. This rate is considerably higher than the England average (2.9 per 1,000 births).

77 of Warwickshire Child Deaths examined were neonatal cases. Of these cases less than a quarter (22%) identified modifiable factors. Out of the factors identified, smoking and pathway or escalation of care contributed to over 50% of cases. Other factors include consanguinity, maternal BMI, domestic violence and illicit drugs or alcohol.

A stillborn baby is one born after 24 completed weeks of pregnancy with no signs of life. In the period 2017-19 the Warwickshire still birth rate (2.7 per 1,000 births) is comparatively low against the national rate (3.99 per 1,000 births).

However, more recent data collected by place across the Coventry and Warwickshire region suggests a rapid increase in stillbirth between 2019/20 and 2020/21, with both North and South Warwickshire experiencing a doubling of instances of stillbirth.