Cumbria Observatory

Overview & Introduction

Welcome to Cumbria’s Joint Strategic Needs Assessment (JSNA). The JSNA is an assessment of the current and future health and social care needs of Cumbria’s local communities. Findings from the JSNA support the development of a Joint Health and Wellbeing Strategy for Cumbria that sets out priorities to improve health and wellbeing outcomes throughout the county and aims to reduce inequalities.

The format of the JSNA in Cumbria has changed from a single document providing a broad overview that is produced every three years, to a continuous rolling programme where individual JSNA topics are investigated in detail and updated every three years. In addition, an executive summary is produced at regular intervals to review strategic headline information, assess trends in recommendations and gaps in information, along with containing information that cannot be included under a single topic area.

A full JSNA overview and introduction, including further information about the JSNA process, is provided below:

JSNA Overview & Introduction

JSNA Topics Timeline (Updated May 2017)

The table below details the individual topics and planned timings. This will be continually reviewed by the Health and Wellbeing Board, and may therefore be subject to change.


Year	Quarter	JSNA topic
2015	1	Executive Summary
	2	Population
	3	Health Inequalities
	4	Healthy Living/Lifestyles
	4	Children and Families
2016	1	Older People
	2	Carers
	3	Executive Summary
	4	Staying Safe
	4	Mental Health and Wellbeing
2017	1	Economy, Learning and Employment
	1	Refugees
	2	Environment and Sustainability
	3	Executive Summary
	4	Autism and Learning Disabilities
	4	Military Veterans
Ongoing	n/a	Core Dataset

Executive Summary

The latest JSNA Executive Summary can be accessed via the link below:

JSNA Executive Summary (August 2016)

Key health and wellbeing need identified in Cumbria

The key health and wellbeing needs have been identified in the Executive Summary as follows:

Children and their families require support to ensure that preventable health issues and effects of poor lifestyle choices are addressed to ensure that every child has a good start in life. There is a need to ensure that the positive progress in early years education is continued.
High levels of unhealthy lifestyles are leading to the development of longer term health conditions such as diabetes and heart disease. Support to promote healthy lifestyles and help people to take more responsibility for their own health and wellbeing, focusing on healthy eating, moderate alcohol intake and increased physical activity will have a positive impact on health and wellbeing and will enable adults in Cumbria to lead healthy and fulfilling lives.
There is a need to improve healthy life expectancy and reduce rates of premature mortality by the early identification and effective management of the main causes.
There is a need to promote mental wellbeing and emotional resilience.
There is a rise in long term and complex health needs due to the needs of Cumbria’s ageing population. There is a need to look at prevention, along with early identification and management of long term conditions to ensure that older people are able to live independent and healthy lives.
Numbers of carers are likely to rise in line with the needs of the county’s ageing population. Carers require support to improve their own health and wellbeing.
There is a need to address the inequalities between the least and most deprived communities and the associated impact on health and wellbeing.
People living in all geographical locations need to be able to access health, social care and support services.

Population

To view the latest JSNA population chapter please click on the link below:

JSNA Population Chapter (January 2015)

Key Issues & Recommendations

As summarised in the above chapter:

Cumbria is England’s second largest county and is much less densely populated than the national average;
Population density varies across Cumbria’s six districts; from 25 people per km2 in Eden to 870 people per km2 in Barrow-in-Furness;
Allerdale was the only Cumbrian district to become less densely populated during the workday. Inversely, Carlisle, Copeland and Barrow-in-Furness became more densely populated during the workday;
54% of Cumbria’s residents live in rural areas compared to 18% nationally;
Of Cumbria’s districts, Allerdale and Eden have the greatest proportions of residents living in rural areas (72% and 71% respectively), while Carlisle has the smallest proportion (27%);
84 of Cumbria’s communities (aka LSOAs) rank amongst the 10% most deprived in England in relation to geographical barriers to services;
LSOAs within Crummock (Allerdale), Seascale (Copeland), Lyne (Carlisle) and Skelton (Eden) rank in the top 25 most deprived out of 32,482 LSOAs in England in relation to geographical barriers to services;
Cumbria’s average travel times to key services are longer than the national average;
Eden had the 2nd longest average travel times to key services out of all Local Authorities (LAs) in England. Eden’s average travel times were longer than similarly sparsely populated LAs;
Cumbria has 29 LSOAs that rank within the 10% most overall deprived in England;
LSOAs within Moss Bay (Allerdale), Barrow Island (Barrow-in-Furness), Central (Barrow-in-Furness), Hindpool (Barrow-in-Furness), Ormsgill (Barrow-in-Furness) and Sandwith (Copeland) rank within the 3% most overall deprived nationally;
Cumbria has a much smaller proportion of residents from Black and Minority Ethnic (BME) groups than the national average (3.5% vs. 19.5%);
Of Cumbria’s districts, Carlisle had the greatest proportion of residents from BME groups (5%);
Seven wards in Cumbria had greater proportions of residents from the White Other ethnic group than the national average: Windermere Bowness South in South Lakeland (9.2%); Windermere Applethwaite and Troutbeck in South Lakeland (9.2%); St Aidans in Carlisle (7.9%); Castle in Carlisle (7.4%); Windermere Town in South Lakeland (7.1%); Kendal Fell in South Lakeland (6.4%); and Ambleside and Grasmere in South Lakeland (5.9%);
Between 2001 and 2011, Cumbria experienced a greater proportional increase in numbers of residents from BME groups than the national average;
Numbers of residents from BME groups increased considerably across all of Cumbria’s districts during the above time, with the greatest increases seen in Carlisle (+143.4%) and Eden (+104.1%);
LSOAs in the wards of Central (Barrow-in-Furness), Hindpool (Barrow-in-Furness), Ormsgill (Barrow-in-Furness), Harbour (Copeland), Barrow Island (Barrow-in-Furness), Moss Bay (Allerdale), Walney North (Barrow-in-Furness) and Sandwith (Copeland) rank in the top 1% most deprived nationally in relation to health and disability;
Cumbria’s proportion of residents reporting that their day-to-day activities are limited by a health problem or disability illness is higher than the national average (20.3% vs. 17.9%);
Of Cumbria’s districts, Barrow-in-Furness had the greatest proportion of residents with day-to-day activities that were limited (24.6%);
Cumbria has a higher proportion of residents providing unpaid care than the national average (11.3% vs. 10.3%);
Barrow-in-Furness also had the greatest proportion of residents providing unpaid care amongst Cumbria’s districts (11.9%);
When compared to the national average, Cumbria has an older age profile;
All of Cumbria’s districts have older age profiles than the national average, with Allerdale, Eden and South Lakeland having the smallest proportions of younger residents and the greatest proportions of older residents;
Projections of recent demographic trends suggest that by 2017 Cumbria’s population will decrease by 1,400 persons (-0.3%), with numbers of 0-14 year olds decreasing by 300 persons (-0.4%) and 15-64 year olds decreasing by 13,500 persons (-4.3%), while numbers of residents aged 65+ increase by 12,300 persons (+11.4%);
Projections based on economic forecasts suggest that by 2017 Cumbria’s population will increase by 17,100 persons (+3.4%), with numbers of 0-14 year olds increasing by 3,000 persons (+3.9%), 15-64 year olds increasing by 500 persons (+0.2%) and 65+ year olds increasing by 13,600 persons (+12.7%);
While projections for Cumbria’s districts vary, all districts are projected to experience an increase in residents aged 65+ to 2017. The greatest increases are projected for Eden (+14% based on recent demographic trends, +16.3% based on economic forecasts);
All of the above statistics vary considerably across Cumbria’s wards and LSOAs;

It is recommended that commissioners ensure that services are designed with consideration of the profile of Cumbria’s population. Because the profiles of communities within Cumbria vary greatly, district and county averages can mask localised need. It is therefore essential that consideration is given to sub-district level information;
It is also recommended that commissioners consider the projected future size and structure of Cumbria’s population, drawing upon jobs led projections produced by the Popgroup software as well as the standard population led projections produced by the Office for National Statistics;
While the Popgroup Experian Jobs Led Scenario, provided within the above chapter, incorporates a range of information about the projected number of future jobs in Cumbria, it does not take into account a number of major potential developments in Cumbria which were not confirmed in 2013 (e.g. nuclear new build and other nuclear related projects) or developments outside of Cumbria which may impact on the county’s population (e.g. high speed rail construction). As details of these developments are made available during the course of 2015 it is recommended that further Popgroup scenarios are developed to consider the potential population impacts of these developments.

Evidence & Research

Evidence and research information including briefings and other publications supporting the Population theme of the JSNA is available via the links below:

Population: Further Information

Health Inequalities

The latest JSNA Inequalities chapter can be accessed via the link below:

JSNA Health Inequalities Chapter (July 2015)

Key Issues & Recommendations

Key Issues –

In Cumbria life expectancy at birth for males is 78.8 years and females 82.4 years which are
lower than the national average of 79.2 years and 83 years respectively.
There is a significant difference in life expectancy across different areas (wards). The
difference in life expectancy at birth between the most and least deprived wards is 16.4
years for males and 14.6 years for females.
Deprivation is associated with inequalities. Cumbria has 29 communities that rank amongst
the most deprived in the England.
Life expectancy at birth in the most deprived quintile of Cumbria (2010-2012) is 74.2 years
for males and 79.3 years for females compared to 81.6 years for males and 84.2 years in the
least deprived quintile in Cumbria.
Health inequalities are apparent right across the life course, even before birth. For example
mothers from deprived areas of Cumbria are more likely to smoke in pregnancy, more likely
to have low birth weight babies and are less likely to breastfeed.
By 2037 the proportion of residents aged 65+ is projected to increase to 32.9% across
Cumbria (Experian jobs projections, 2013).
Poverty and income inequality are key drivers of poor health. Living in poverty is closely
related to other factors that influence health such as education, living environment,
employment and lifestyle.
Educational attainment significantly affects future life chances. In 2014 56.8% of children in
Cumbria obtained five or more Key Stage 4 exams (GCSE) with grades A*-C– including
English and Mathematics. However, there are significant variations in communities across
the county with just 21.1% of children living in the ward of Upperby in Carlisle compared to
91.7% of children living in the ward of Ulverston West in South Lakeland.
Lifestyle related issues such as smoking, excessive alcohol use and obesity show strong
associations with deprivation and thus contribute to inequalities.

Recommendations for Consideration for Commissioners –

Tackling inequalities involves action by all organisations and sectors throughout Cumbria. Action is
required if we are to give all people in Cumbria the opportunity for a long, healthy and happy life. In
order to address health inequalities in Cumbria commissioners should:

Have a universal approach to commissioning throughout Cumbria which is proportionately
targeted (proportionate universalism) to deprivation and socioeconomic status.
Ensure that reducing health inequalities are key objectives for all, by ensuring a collaborative
approach to tackling the wider and social determinants of health such as employment,
income, housing, occupation and deprivation.
Adopt a life course approach; all partners should work together to establish a clear and co-
ordinated programme to intervene early when problems first arise to support the health and
wellbeing of children and young people.
Work together to maximise opportunities for local communities to exercise an increasing
degree of influence and control over decision making, service provision, with support for a
community development approach.
Focus on the causes of death which contribute most to reduce life expectancy and that can
have the biggest impact on health inequalities.
Monitor inequalities on an ongoing basis through district or locality action plans that can be
governed through the Public Health Alliance and Health and Wellbeing Forums.
Undertake further Health Inequalities JSNA work at a locality level to include qualitative data
to gain local knowledge about the experiences of the local community.
Explore how we fill local current data gaps for Lesbian, Gay, Bisexual and Transgendered,
Black and Minority Ethnic Groups or other groups with protected characteristics.
Conduct a Homelessness Health Need Audit to address health inequalities and establish the
health needs of single homeless people in each local authority area.

Evidence & Research

Evidence and research information including briefings and other publications supporting the Inequalities theme of the JSNA is available via the links below:

Healthy Living/Lifestyles

The latest JSNA Healthy Living and Lifestyle chapter can be accessed via the link below:

JSNA: Healthy Living & Lifestyles Chapter

Key Issues & Recommendations

As summarised in the above chapter:

Key Issues

Alcohol misuse

Based on the Acorn type profile of Cumbria’s residents, the county has slightly greater estimated proportions of women who consume more than 3 units of alcohol per day (Cumbria 30.1% vs. UK 28.8%) and men who consume more than 4 units of alcohol per day (Cumbria 42.4% vs. UK 41.4%).
The directly standardised rate per 100,000 population for alcohol related hospital admissions in people aged 18+ in Cumbria between 2008/09 and 2012/113 is consistently significantly higher than England.
The rates for Allerdale, Barrow-In-Furness and Copeland have been consistently above the national average during this time. In Allerdale the rate of alcohol specific mortality in females of 12.9 per 100,000 was significantly worse than England at 7.5 per 100,000.

Substance misuse

Throughout 2014-15 there were 3,118 service users in contact with Unity (the provider of statutory drug and alcohol services in the county). Most service users (57.7%) use the service for drugs related issues; 42.3% use the service for alcohol related issues. Heroin is the main drug of services users across all districts.
6000 people have registered for needle exchange with the majority of users reporting performance enhancers as their main drug.
Drug crime has fallen marginally across the county. Throughout 2013-14 there were 1,529 drug offences in Cumbria, 0.1% decrease from the previous year.

Smoking

In 2011/13 an estimated 296.5 deaths in Cumbria were attributable to smoking per 100,000 population (aged 35+); this was similar to the national average of 288.7 per 100,000 population. However, the county average masks variation between districts; with Allerdale, Barrow-in-Furness, Carlisle and Copeland all having significantly worse rates than the national average, while Eden and South Lakeland’s rates were better than the national average.
There were 2,063 smoking attributable hospital admissions in people aged 35 and over per 100,000 population in 2011/13; this was significantly worse than the national rate of 1,645 per 100,000 population. Furthermore, all of Cumbria’s districts except Eden had worse rates than the national average.
Smoking prevalence in Cumbria at 18.1% is similar to national figures
13.8% of pregnant women in Cumbria were smoking at the time of delivery; this is significantly worse than the national average of 12%.
There is little understanding of e-cigarette use in Cumbria.

Healthy Weight and Healthy Eating

The Active People Survey in 2012 recorded adult excess weight and in Cumbria 68.3% of the population is estimated to be overweight and this is significantly higher than England which is 63.8%. In the survey Copeland district reported the highest proportion of adults overweight in the country at 75.9%. The districts Carlisle and Eden also have a proportion overweight greater than England, 68.4% and 68.8%.
The obesity prevalence in adults (BMI over 30) ranges from 1.41% and 18.58% in Cumbria CCG practices compared to 9.84% across England.

Physical Activity

Although the percentage of adults (16+) who report undertaking 150 minutes of moderate intensity physical activity for Cumbria is higher at 56.3% than the national average (55.6%), some of the districts e.g. Barrow-in-Furness (52.3%) and Carlisle (50.4%) are significantly below the national average.
The percentage of adults who are inactive is higher in Barrow-in-Furness (36.1%) and Carlisle (35.1%), in comparison the figure for Cumbria (31.1%).
There is currently no up to date robust data available at a local level which details physical activity participation levels in children and young people.

Sexual Health

STI testing rates have been well below the national average between 2012 – 2014. Testing rates are increasing in all districts despite this they remain below England levels.
Recent increases in rates of both syphilis and gonorrhoea is predominantly in homosexual men aged 25-34 years, similar to the national picture.
Public Health England recommends that local authorities should be working towards achieving a chlamydia detection rate of at least 2,300 per 100,000 population. Cumbria currently has a detection rate of 1,707 per 100,000 aged 15-24 years. All districts except Carlisle have a detection rate below 2,300 per 100,000.
51.5% of adults presenting with HIV do so at a late stage in Cumbria compared to 48.3% in England. HIV testing uptake is below national rates, with 68.2% uptake in Cumbria compared to 77.5% in England.
There are not currently free condoms available to patients via GP practices unless provided by the practice themselves.

Recommendations for Consideration for Commissioners

Although each lifestyle factor has been addressed in separate section the vulnerable groups often overlap and the behaviours are not to be viewed in isolation. It is recommended commissioners consider all aspects included in this summary when considering healthy living and lifestyle.

Children and Families

The latest JSNA Children and Families chapter can be accessed via the link below:

JSNA Children and Families Chapter

Key Issues & Recommendations

As summarised in the above chapter.

Key Issues

There are many children and young people’s health and wellbeing measures for which Cumbria performs better than the national average; these are identified later in this chapter. However, evidence provided within this chapter also suggests that the county performs less well than the national average in relation to the areas identified below.

58.6% of Cumbrian children achieve a good level of development at the end of reception (school readiness); lower than the national average (60.4%). Furthermore, when compared to the national average: Barrow-in-Furness and Carlisle have lower proportions of pupils achieving 5+ GCSEs at grades A*-C including English & Maths (50.5% and 47% respectively vs. 56.8% nationally); Carlisle has worse absence rates (4.9% of school sessions missed due to overall absence vs. 4.5% nationally and 4.6% of pupils classed as persistent absentees vs. 3.6% nationally); and Cumbria has a higher rate of fixed period exclusions (368 vs. 350 per 10,000 pupils nationally). The youth unemployment rate in Cumbria is higher than the national rate (3.4% v 2.9%), with particularly high rates found in Barrow, Copeland and Allerdale (5.8%, 5.3% and 4.9% respectively).
NHS Cumbria CCG had 385 observed unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s in 2013/14; this equates to a rate of 381.4 per 100,000 registered patients under 19 (higher than the national average of 311.4), with under 19s admissions for epilepsy in the area being in the highest quartile of all CCG areas nationally.
Cumbria has worse rates than the national average in relation to mothers smoking at time of delivery (13.8% vs. 12% nationally) and breastfeeding initiation (66.4% vs. 73.9% nationally). Amongst Cumbria’s districts, rates of breastfeeding initiation are worse than the national average in Allerdale, Barrow-in-Furness, Carlisle and Copeland. Breastfeeding continuation data is inconsistently recorded throughout the county.
25.1% of Cumbria’s 4-5 year olds have excess weight; worse than the national average of 22.5%. Allerdale, Barrow-in-Furness and Copeland all have worse rates than the national average for this measure, with Barrow being rating worst out of all local authorities in England (30.6%). Additionally, compared to the national average, Year 10 females in Cumbria are less likely to say they enjoy physical activity (53% vs. 61% nationally) and secondary pupils in Cumbria are less likely to say they walked to school (35% vs. 40% nationally).
Carlisle has significantly higher rates of tooth decay in 3 year olds than the national average. In addition, Cumbria’s 5 year olds have higher rates of tooth decay than the national average (1.16 vs. 0.94 mean decayed missing or filled teeth per child nationally), with Barrow-in-Furness, Carlisle and Copeland all having significantly higher rates than the national average for this measure.
Cumbria’s rate of hospital admissions caused by unintentional and deliberate injuries in children aged 0-14 years is worse than the national average (133.7 vs. 112.2 per 10,000 population nationally) and an increase the previous year (119 per 10,000). Barrow-in-Furness, Carlisle and Copeland all have significantly higher rates than the national average for this measure. Cumbria’s rate of hospital admissions caused by unintentional and deliberate injuries in young people aged 15-24 years also worse than the national average (160.1 vs. 136.7 per 10,000 population nationally) and an increase from the previous year (155.3 per 10,000). Barrow-in-Furness, Copeland and South Lakeland have significantly higher rates than the national average for this measure.
Cumbria’s rate of under 18s alcohol-specific hospital admissions is significantly worse than the national average (68 vs 40.1 per 100,000 population nationally). Allerdale, Barrow, Copeland and South Lakeland all have rates that are worse than the national average for this measure, with Copeland having the highest rate of all local authorities in England. Cumbria’s rate of hospital admissions due to substance misuse for 15-24 year olds is significantly higher than the national average (118.1 vs 81.3 per 100,000 population nationally).
Cumbria’s rate of new Sexually Transmitted Infections, including chlamydia, in 15 to 24 year olds was lower than the national average (2,575 vs. 3,433 per 100,000 population nationally). Cumbria has not reached the target Chlamydia detection rate (1,526 detections per 100,000 vs. national target of 2,300). Of Cumbria’s districts, only Carlisle has a detection rate above the national target. Surveys suggest that, of those sexually active, just over 40% of young people use condoms and there is low awareness of the Sexual Healthline.
Cumbria’s rate of killed or seriously injured road casualties is significantly worse than the national average (45.7 vs 39.7 per 100,000 population nationally). Eden, South Lakeland and Allerdale have significantly worse rates than the national average for this measure.
Cumbria’s rate of 10-17 year olds receiving their first reprimand, warning or conviction (known as first time entrants) increased in the most recent year (438 per 100,000 population up from 329 per 100,000).
Surveys suggest that Cumbria’s secondary school pupils are less likely to have a self-esteem score in the highest bracket than the national average (33% vs. 44% nationally). The fear of bullying amongst Year 6 pupils has increased in Cumbria since 2003 and is 5% higher than the national average. Cumbria’s rate of child admissions for mental health is significantly higher than the national average (110.6 vs. 87.2 admissions per 100,000) and has increased from the previous year (70.9 admissions per 100,000). Cumbria’s rate of young person hospital admissions for self-harm is also significantly higher than the national rate (467.8 vs. 412.1 per 100,000 nationally) and has increased from the previous year (458.7 per 100,000). Cumbria’s rate of mortality from suicide and injury undetermined in those aged 15-44 years is significantly higher than the national average (14.3 vs. 10.1 per 100,000 nationally).
There are a number of groups of children and young people identified within this chapter as being particularly vulnerable to poor health and wellbeing outcomes. These groups include:

Children Living in Poverty and Deprivation;
Children in Need;
Children Subject to a Child Protection Plan;
Children Looked After;
Children with Special Educational Needs or Disability;
Gypsy and Irish Travellers;
Young Carers;
Children Living with Domestic Violence;
Children Living with Parental Drug & Alcohol Misuse;
Children Missing from Home;
Children who are Homelessness or Not in Suitable Accommodation;
Children at Risk of Sexual Exploitation.

Barrow-in-Furness has a greater proportion of children living in poverty than the national average (20.4% vs. 18.6% nationally) and there are 10 wards in Cumbria which fall within the bottom 10% nationally for levels of child poverty. Cumbria has 29 LSOAs that rank within the 10% most deprived nationally, with 8.3% of the county’s population living these LSOAs.
In Cumbria there are 3,421 children in need (363.9 per 10,000 population), 325 children with a child protection plan (34.6 per 10,000 population), and 681 children are looked after by CCC (72.4 per 10,000). Cumbria had higher rates of these three groups than the national average in 2014. 11,203 pupils in Cumbria have SENs (15.6%) and 2,141 pupils have a Statement/ EHC plan (3%); similar to the national average (15.4% and 2.8% respectively).
In Cumbria 1,123 children aged under 15 (1.3%) are reported to provide unpaid care, with 90 (0.1%) providing 50+ hours unpaid care a week. Cumbria’s rate is slightly higher than the national average for this measure (1.1% nationally). Of Cumbria’s districts, Eden has the greatest proportion of children providing unpaid care (1.7%).
Cumbria has a lower rate of incidents of recorded domestic abuse than the national average (16.6 vs. 19.4 per 1,000 population nationally). However, Cumbria’s rate has increased from the previous year (15.7 per 1,000). In 2011/12, 92 parents in Cumbria were attending treatment for substance misuse (110.4 per 100,000 children aged 0-15), which was the same as the national average rate.
In the last year there were 1,017 cases of people missing from home for more than 24 hours in Cumbria, with under 18s accounting for 58% of these cases. Cumbria had a total of 63 applicant households with dependent children or pregnant woman accepted as unintentionally homeless and eligible for assistance in the last year (0.3 per 1,000 households); significantly better than the national average (1.7 per 1,000 households). In the last year 147 contacts have been made through Cumbria’s Safeguarding Hub for 16-17 year olds with a presenting issue of homelessness. There were 9,644 vulnerable child reports in Cumbria in the most recent year, of which 139 were relating to child sexual exploitation.
The Cumbria Intelligence Observatory found that children in need, children on child protection plans and children looked after are much more likely to originate from the areas of the county with the highest levels of deprivation and child poverty, while young carers in Cumbria are more likely live in areas belonging to the most deprived socio-economic categories (© 1979 – 2015 CACI Limited. This data shall be used solely for academic, personal and/ or non-commercial purposes).

Recommendations for Consideration by Commissioners

This chapter identifies many factors which influence the health and wellbeing outcomes of children and young people. In particular, the chapter highlights importance of the early years in giving all children the best start to enable them to stay healthy, as well as the detrimental impact that risk taking behaviours and mental health issues can have on outcomes.
Although each factor has been addressed in separate sections within the chapter, evidence shows that factors are clearly interlinked and should therefore not to be viewed in isolation. Furthermore, evidence also illustrates that there are a number of groups of children and young people who are especially vulnerable to poor health and wellbeing outcomes across many of the factors identified.
It is recommended that commissioners fully investigating the evidence base and consider all factors identified within this chapter holistically when developing services to support health and wellbeing outcomes of Cumbria’s children and young people, in order to provide a universal offer alongside targeted intervention for those vulnerable groups who are most in need.

Evidence & Research

Evidence and research information including briefings and other publications supporting the Children and Families theme of the JSNA is available via the links below:

Older People

The latest Older People chapter can be accessed via the link below:

JSNA: Older People chapter

Key Issues & Recommendations

As summarised in the above chapter:

Key Issues

The Cumbrian population is ‘super-ageing’. This means that the population of Cumbria is ageing faster than the rest of the UK population and the number of people of working age is reducing. By 2020, nearly 25% of the Cumbrian population will be aged over 65. As people grow older, their health needs become more complex with physical and mental health needs impacting on each other. As an example, there are an estimated 7,721 people living with dementia in Cumbria, with around 1,800 being diagnosed each year. As our population ages this number is expected to rise substantially to 12,410 by 2030. NWAS (North West Ambulance Service) data indicates that falls comprise approximately 88% of all injuries serious enough to warrant an ambulance call out for people aged 50 years and over.

Among older people there are inequalities in terms of deprivation and health outcomes, life expectancy and general health, and it is often the poorest older adults who suffer the greatest disadvantage.

The rurality of Cumbria is a significant factor for older people. Anecdotal evidence from Age UK across Cumbria suggests that access to health and social care services remains a real issue. This is mainly due to access – transport availability; variable clinic locations across Cumbria; challenges to get appointments with GPs; and routine appointments not fitting with bus timetables. Within Cumbria the challenges faced by our communities to ageing well vary between the rural and built environment. Connectivity to services in rural areas is a challenge. In Cumbria, 84 communities (LSOAs) rank amongst the 10% most deprived in England in relation to geographical barriers to services. Standards that may be achievable in an urban area may be difficult in a rural area and vice versa. Internet usage for older people in Cumbria cannot be quantified, but as the age profile in Cumbria is older than the UK it would suggest that internet usage will be lower than the national average.

Communities are a key asset in Cumbria. There are more than 56,000 residents across Cumbria providing unpaid care to either family members, friends, neighbours or others because of long-term physical or mental ill-health / disability or problems relating to old age. There are greater proportions of carers in Cumbria compared to the rest of England (Provision of unpaid care, Source: Census, 2011). A survey in 2009 indicates there are approximately 50,000 volunteers providing support through registered charities across Cumbria, providing on average 1 hour 25 minutes per week. There are reported divisions in communities such as incomers verses those born in an area, rich verses poor, and urban verses rural. Ethnic minority and gay community involvement is also often challenged. There also appears to be some gaps in long term strategies for ongoing issues e.g. volunteer car schemes.

Cumbria Emergency Departments (and Royal Lancaster Infirmary) do not currently categorise falls, which compromise the main injury group among older people, particularly those aged 65 years and over. While it is assumed that the majority of ‘other injuries’ are falls, especially among older age groups, it would be useful for the purposes of prevention and treatment to distinguish between falls and other accidents, and therefore to consider mechanisms to enable the further categorisation of unintentional injuries to include falls.

Recommendations for Consideration for Commissioners

Commissioners need to consider barriers to ageing well for older people, this is across various arenas and includes access to services.
With Cumbria’s super-ageing population commissioners should ensure future assets and commissioned services are sustainable.
Identify risk groups in the older population in Cumbria and prioritise prevention.

Evidence & Research

A range of evidence and research information including briefings and other publications supporting the JSNA is available at the links below.

Social isolation and loneliness

Carers

The latest JSNA Carers chapter can be accessed via the link below:

JSNA Carers

Key Issues & Recommendations

As summarised in the above chapter.

Key Issues

Cumbria’s population is ‘super-ageing’ and is ageing faster than the rest of England; numbers of people aged 65+ years are projected to increase while numbers of the working age population (16-64 years) are projected to fall.
Numbers of people with long-term health conditions and dementia are projected to increase; people with cancer are living for longer, creating a greater demand and need for carers in the future – it is important to ensure that the right level of support is available to meet the increasing need.
1 in 5 people in Cumbria have a limiting long-term illness or disability while almost 1 in 3 carers in have a long-term health problem or disability themselves.
Areas with high levels of deprivation have poorer health, however, it is likely that the provision of care is under reported in these areas.
The number of carers is thought to be significantly underestimated; despite existing services and support networks already in place many carers remain hidden. Male carers are less likely to be identified as they may not be accessing help or support.
All health and social care organisations have a key role in helping to identify carers’ and ensuring help and support services are accessible.
There is a gap in the Adult Social Care reporting systems within Cumbria County Council; limited information about carers is known as information and service provision is often recorded against the person being cared for rather than the carer.
Historically, there has been low numbers of individual Carers Assessments and high numbers of Joint Assessments within Cumbria County Council; Joint Assessments do not always pick up the needs of the carer and therefore individual Carer Assessments should be carried out.
More than half of Cumbria’s population are living in a rural area therefore services need to be delivered in a way which ensures help and support is accessible, for example digital solutions where possible and community support
There is no Children & Young People with caring responsibilities lead within Cumbria County Council, therefore there is a risk that referrals for appropriate support and intervention from the information provided by Carers Support Cumbria is not being acted upon.
Numbers of referrals from Adult Social Care practitioners are reducing; and there are concerns from organisations that assessments are not always offered to the carer. In addition to this, there is no referral system set up with housing organisations. There are concerns from organisations that assessments are not always offered to the carer by the social care worker.
Quality of life is important to carers. The highest level of need amongst carers is around being able to participate in activities outside of caring that they value and enjoy, and having control over their daily lives. Respite care, even if only for a few hours to provide a break, can help to facilitate this and is considered important by carers.
There are barriers to services in terms of information and procedures – it is felt they are over complicated. Carers have concerns about the number of agencies and organisations involved, and the feeling of being passed around between different organisations.
There are gaps in relation to support services provided to parent carers – greater communication between professionals and parents is needed; and a more joined up approach. Evidence gathered suggests that there is a gap in the support provided for 16-18 year olds and in particular poor quality of transition into adult services. Some parent carers feel that there is a lack of support from schools, and teachers do not always understand how to deal with situations; some also feel that there is a lack of crisis support and bereavement support for families.
Further clarification is required in terms of parent carer assessments – the role of Carers Support Cumbria needs to be defined.

Staying Safe

The latest JSNA Staying Safe chapter can be accessed via the link below:

JSNA Staying Safe Chapter (August 2016)

Key Issues & Recommendations

As summarised in the above chapter.

Key Issues

Cumbria is a relatively safe place in which to live, work and visit. In many areas, crime and community safety issues are better than the national and / or North West regional average and these areas are identified within this JSNA chapter. However, evidence within this chapter suggests there are some areas of concern in relation to ‘staying safe’.

There is not always a correlation between the chances of becoming a victim of crime and the fear of crime. Of the 21 wards identified as being least safe, around one in five (19.0%, 4) did not rank in the top 15 wards for any fear of crime categories.

The link between crime and deprivation is well documented and has long been understood. Cumbria has 29 communities (Lower Super Output Areas) that rank within the 10% most deprived in England, with the most deprived community in the county located within Central ward in Barrow-in-Furness. In total, over half (52.4%, 11) of the 21 wards identified as being least safe contain communities that rank within the 10% most deprived in England.

Protected characteristics can make people more vulnerable to crime and safety. Evidence within this JSNA chapter shows that age, gender and pregnancy are factors: pregnant women are vulnerable to domestic abuse; young females (particularly those aged 25 to 29 years) are more likely to be victims of violence against the person offences; females are more likely to be victims of sexual offences, particularly those aged from 0 to 17 years. Disability, transgender, race, religion and belief, and sexual orientation are drivers of hate crime incidents. Age and disability are additional factors making people vulnerable.

Crime and Community Safety: Who is at Risk?

Evidence within this chapter indicates that the group most likely to become victims of crime as well as offenders are males aged between 18 and 30 years. There are some exceptions, and gender is a factor in becoming a victim in some crime areas. Females aged between 18 and 30 years are more likely to become victims of theft from the person offences and young females are more likely to become victims of sexual offences. In 2015-16, three quarters (75.4%) of victims of sexual offences were female, with those aged from 0 to 17 years the group most at risk.

Violence against the person affects both sexes. Both males and females aged between 18 and 30 years are more likely to become victims of violence against the person offences, whilst those aged 18 to 40 years are the group most at risk of alcohol related violence against the person offences.

People missing from home are more likely to be aged from 12 to 17 years and living in residential care homes or local authority care. Children missing from home are the group who are most at risk of experiencing abuse and sexual exploitation.

In 2014-15, the majority (79.1%) of First Time Entrants to the Youth Justice System were male. A large proportion (29.4%) of First Time Entrants had already had involvement with Cumbria’s Children’s Services.

Cumbria’s communities face risks in their own homes. Fire is a greater risk for people who smoke, for those who live in areas where there are high levels of poverty and deprivation, those who are single parent families, single person households, social renters, those who are disabled or suffer from illness, or those who are unemployed.

Adults (those aged 18 and over) with health or social care needs are more at risk of abuse or neglect.

Out and about on the county’s roads, it is young, recently qualified drivers who are most at risk of death or serious injury whilst driving. Young male drivers are the group more likely to incur risks by drink-driving and drug-driving.

Crime and Community Safety Trends

In 2015-16, overall crime levels increased in Cumbria by +5.0% (+1,243) compared to 2014-15, and +8.4% (+2,018) compared to 2013-14. Of Cumbria’s districts, the largest percentage increase was seen in South Lakeland +14.9% (+516). The highest number and rate of overall crime was seen in Castle ward in the Carlisle district with a total of 1,820 crimes, a rate of 317.6 per 1,000 population.

Offence rates varied across different crime categories. Burglary (dwelling) offences increased in 2015-16 by +7.9% (+56) compared to 2014-15 and +9.3% (+65) compared to 2013-14. The highest percentage increase occurred in the Copeland district +28.4% (+23) whilst Carlisle had the highest crime rate for burglary (dwelling) at 2.2 per 1,000 population.

Violence against the person offences increased +12.6% (+826) in 2015-16 compared to the 2014-15. Barrow-in-Furness had the highest offence rate for violence against the person offences (21.3 per 1,000) whilst Carlisle had the highest number of crimes (2,017). Domestic abuse incidents increased by +1.1% (+81) in 2015-16 compared to 2014-15 and by +2.8% (+195) compared to 2013-14. Eden district had the largest increase in recorded domestic abuse incidents (+19.0%; +60); the largest number of recorded domestic abuse incidents occurred in the Carlisle district (1,887).

Reported sexual offences also increased in 2015-16, by +23.5% (+163) compared to 2014-15, and +102.1% (+433) compared to 2013-14. Increases were seen in all districts except Allerdale and Barrow-in-Furness. Carlisle district had the largest percentage increase +58.9% (+76). Although hospital admissions for violent crime (including sexual violence) have decreased in 2012-13/2014-15, the rate in Barrow-in-Furness (69.0 per 100,000) remains significantly worse than England (47.5).

Anti-social behaviour incidents increased in Carlisle and Allerdale in 2015-16 comparted to 2014-15 (+20.4% / +192 and +17.9% / +108 respectively). Criminal damage offences (including arson) increased across the county by +5.0% (+245) compared to 2014-15.

Recorded hate crimes (all types) also saw an increase across the county, rising by +12.1% (+41) to a total of 379 in 2015-16 compared to 2014-15, +60.6% (+143) compared to 2013-14. Hate crime increase across all Cumbria’s districts, and the majority were racially motivated. Copeland district experienced the highest percentage increase (+100% / +25).

In 2013, almost a third of Cumbria’s offenders (29.1%) went on to re-offend, +1.7 percentage points compared to the previous year. This proportion is higher than both the proportion in the North West (28.0%) and England (26.4%). The largest proportion of offenders who went on to re-offend in 2013 occurred in Barrow-in-Furness district (31.8%).

Alcohol has a significant impact on crime and community safety being directly involved in 13.9% (3,626) of all crimes in 2015-16, +2.4% (+84) compared to 2014-15. Alcohol played a part in a large proportion of all violence against the person offences in 2015-16 (29.3%; 2,161).

Eden district saw the largest percentage rise in all alcohol related crimes in 2015-16 (+24.0%; +42) and the second largest percentage increase in alcohol related violence against the person offences (+9.8%; +11).

The largest increase in terms of numbers of all alcohol related crimes occurred in the Carlisle district +153 (+18.2%), and Carlisle also saw the largest percentage increase in alcohol related violence against the person offences in 2015-16, +10.1% (+52). Support is available from Unity Drug and Alcohol Services Cumbria (Unity) for people misusing drugs and alcohol. Reflecting the rise in alcohol related crime, the data show that alcohol misuse referrals to Unity increased in Carlisle in 2015-16 (+5.9%, +16). Carlisle had the largest number of Unity drug and alcohol clients in 2015-16 of all the districts (790 clients). Alcohol misuse is having a detrimental effect on health within the Carlisle district, with an increase in the district’s male alcohol specific mortality rate of +23.8% to 14.7 per 100,000 in 2012-14, the second highest percentage increase of all the districts.

Barrow-in-Furness had the second largest number of Unity drug and alcohol clients in 2015-16 (616 clients). Data show that alcohol specific hospital admissions (all persons, all ages) in Barrow-in-Furness (689 per 100,000) are significantly worse than both the North West (558) and England (364), having increased by +13.9% compared to 2012-13 and by +17.8% compared to 2010-11. Across Cumbria, alcohol specific hospital admissions for under 18 year olds in 2012-13/2014-15 (crude rate 58.2 per 100,000 population) are similar to the North West region (53.5 per 100,000) and significantly worse than England (36.6 per 100,000). However, within the Barrow-in-Furness district, alcohol specific hospital admissions for under 18 year olds (90.2 per 100,000) are significantly worse than the North West. This is also the case in the Copeland district, where alcohol specific hospital admissions for under 18 year olds at 104.4 per 100,000 population are significantly worse than the North West, and the highest of all Cumbria’s districts.

Alcohol specific hospital admissions (all persons, all ages) in South Lakeland in 2014-15 (333 per 100,000) are now similar to England (364), having previously been significantly better.

Alcohol misuse is having a detrimental impact on health in the Allerdale district. Allerdale’s female alcohol specific mortality rate in 2012-14 (16.4 per 100,000) increased by +25.2% compared to the 2011-13 rate of 13.1 and by +72.6% compared to the 2010-12 rate of 9.5 and was significantly worse than England (7.4) in 2012-14. Allerdale district’s male alcohol specific mortality rate also increased in 2012-14 by +47.2% to 22.5 per 100,000, the highest percentage increase of all Cumbria’s districts.

Copeland was the only district in 2015-16 with a significant increase in drug misuse referrals to Unity (+18.5%; +38).

Vulnerable Adult alerts to Cumbria County Council’s Health and Care Services increased by +20.3% (+397) to 2,349 in 2015-16 compared to the previous year. The incidence of physical abuse made up 48% of all referrals, significantly higher than the England average of 27%. Psychological abuse (12%) and financial abuse (13%) are slightly below the England averages of 16% and 18% respectively. Neglect has risen by 3.0 percentage points to 25% of all cases, but is below the England average of 29%. The majority of alerts (47%) continue to be in relation to people living in a care home setting, higher than the England average of 36%.

Recommendations for Consideration by Commissioners

This JSNA Staying Safe chapter identifies a range of factors which can have a significant impact on the health and wellbeing of Cumbria’s communities. Although different aspects of crime and community safety have been addressed separately, the groups and communities affected are often similar, and the issues should not be viewed in isolation. It is recommended that commissioners consider all aspects included within this JSNA chapter when developing services to support communities to be safe, and feel safe, in Cumbria.

Evidence & Research

Evidence and research information including briefings and other publications supporting the Stay Safe theme of the JSNA is available below:

Avoidable Mortality: Road Traffic Collisions (April 2015)

Mental Health and Wellbeing

The latest Mental Health chapter can be accessed via the link below.

JSNA Mental Health, December 2016

Key Issues & Recommendations

Key Issues (Summary)

The Adult Psychiatric Morbidity Survey (APMS) gathers information on mental illness among adults living in private households. Of those surveyed in 2014, 1 in 6 had a common mental health disorder (CMD); 1 in 5 women and 1 in 8 men. Based on these estimates and current population, in Cumbria there are around 70,770 people aged 16+ years with a common mental health disorder; 44,049 women; and 26,862 men. People with CMD are often hidden and untreated with just 1 in 3 people with a CMD reporting current use of mental health treatment.

Other disorders such as psychotic disorder and autism were more rare, affecting around 1 in 100. Bipolar disorder is more common affecting 1 in 50. Drug dependence was evident in 1 in 30; with a similar level found for probable alcohol dependence. Both types of substance dependence were twice as likely in men than in women.

In the 2014 Adult Psychiatric Morbidity Survey (APMS), the population identified as most at risk of poor mental health (common mental health disorders) are females aged 16 to 24 years; and also both men and women aged 55-64 years.

There are various risk factors associated with mental illness. In Cumbria populations with rates higher than the national average are single person households, working age people without formal qualifications, those experiencing insolvency, households with an income less than £10,000 and people with a long term health problem or disability. The risk factors affecting the largest number of people in Cumbria are those people with long-term health problems or disabilities and single person households.

Rates of suicide in Cumbria are higher than the national average. The circumstances surrounding suicide are often complex and that there isn’t just one risk or attributable factor.

Recommendations for Consideration for Commissioners

As set out in The Five Year Forward View for Mental Health, the picture of mental health is changing, public attitudes towards mental health are improving, and there is a growing commitment among communities, workplaces, schools and within government to change the way we think about it. There is now a cross-party, cross-society consensus on what needs to change and a real desire to shift towards prevention and transform NHS care. It is recommended Commissioners of mental health care consider the population needs included in this document.

Evidence & Research

Evidence and research information including briefings and other publications supporting the Mental Health and Wellbeing theme of the JSNA is available via the links below:

Avoidable Mortality: Suicide
Children and Young People Emotional Health and Wellbeing in Cumbria: Joint Strategic Needs Assessment [refresh]

Economy & Employment

The latest JSNA Economy & Employment chapter can be accessed via the link below:

JSNA Economy & Employment (June 2017)

Key issues and recommendations:

Issues:

Areas in Cumbria which experience highest rates of health deprivation are frequently also those which experience highest rates of claimant unemployment, lowest levels of qualifications and highest levels of economic inactivity.
Economic activity rates and full time employment rates for those whose activities are limited by poor health or who have low / no qualifications are significantly lower than for those with high level qualifications or without limiting health conditions.
Claimant unemployment rates among age groups below 35 years are above the national average particularly in west and south Cumbria. However, NEET rates for 16-17 year olds are lower than the national average suggesting that intervention is required to improve progression rates.
Occupation projections suggest that over 100,000 jobs will need to be filled in Cumbria in the next decade as a result of expansion demand or replacement demand and that an increasing proportion of jobs will require high level skills which has the potential to increase the barriers to employment for those with low skills and for those at most disadvantage in the labour market.
Demographic decline is leading to a shrinking working age population and increasingly ageing workforce which may constrain future economic growth unless activities to increase labour market participation from the resident population (including the over 50s) and to encourage inward migration from younger age groups into Cumbria are strengthened.
One in seven businesses already identifies current skills gaps in their business, most likely to be in skilled trades and lower skilled elementary administration and service occupations and for technical & practical skills, advanced IT or software skills.

Recommendations for consideration by commissioners:

Foster a closer relationship between Cumbria Local Enterprise Partnership (LEP) and the Health and Wellbeing Board;
Ensure effective partnership focus on the important relationships between employment, worklessness and health and support appropriate interventions in a coordinated manner to reduce duplication and maximise effectiveness;
Work together to promote the benefits of workplace health and wellbeing including supporting programmes such as the Better Health at Work Award;
Ensure a strong foundation of general education and develop an appropriately skilled population taking account of current and future expected growth sectors within the economy and the challenge of replacement demand;
Prioritise active labour market programmes which tackle inequality in employment, skills and employability;
Recognise the challenges and opportunities of an ageing population and adopt policies which encourage continued labour market participation by over 50s, including promoting the benefits to employers of employing older workers, encouraging them to upskill/retrial older workers by adapting training and development to suit this cohort and to adopt more age friendly policies;
Adopt and promote commissioning and procurement policies which impact positively on Cumbria’s businesses and communities by recognising the social, economic and environmental benefits to be gained through responsible procurement activity, thus strengthening community resilience and building social capital, including applying social benefit clauses to contracts where appropriate.

Refugees

The latest JSNA Refugees chapter can be accessed via the link below:

JSNA Refugees Chapter (April 2017)

Key issues and gaps

Language is a key enabler to preventing barriers for various elements of health and wellbeing for refugees. There is a need to ensure accessibility to appropriate level language classes for refugees and accessibility to all including females and carers. Language classes should be at a suitable location in close proximity to residency.

There is a possibility of mental health issues including severe conditions for refugees. As well as service provision there is a need to ensure access is facilitated for those refugees who may not discuss mental health issues easily or have less contact with other services.

Informing and preparing local communities for the arrival of refugees is an essential part of the resettlement and integration process.

Recommendations for consideration by commissioners

This JSNA chapter identifies several factors that will affect the health and wellbeing of refugees. It is recommended that commissioners consider the following elements in relation to the needs of refugees when developing services:

With any service provision/support consider the importance of language skills; the impact cannot be underestimated;
Consider cultural differences when providing services;
Encourage active engagement between refugees and local communities to develop mutual understanding and promote social integration;
Encourage local employers and Third Sector organisations to offer work experience placements to resettled refugees.

Environment and Sustainability

This chapter of the JSNA is not currently available. To find out when this topic is due to be updated, please consult the JSNA topics timeline above.