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					                       WARRINGTON

JOINT STRATEGIC NEEDS ASSESSMENT



5                       Children and Young People




        This section provides a profile of the health and well-being of
        children and young people living in Warrington. In particular
    highlighting those factors known to impact on; child health, fertility,
     health behaviours of pregnant women, babies, children and young
      people, child protection, educational attainment, economic well-
    being, oral health, childhood immunisations and teenage pregnancy.
5. Children and Young People

This part of the JSNA provides a profile of the health and well-being of
children and young people living in Warrington. It is based mainly on routinely
available data, collated into one section. Where possible, statistics are
provided at a local level and comparisons are made with regional and national
averages. More detailed information on the health of children and young
people in Warrington can found in the Children and Young People Health
Needs Assessment which was produced in 2007.1

This section aims to provide information on factors known to impact on child
health, and includes sections on fertility, and information on the health
behaviours of pregnant women. Further sections relate to the health of babies
and to the health of children and young people. Information is also included
on child protection, educational attainment, economic well-being, oral health,
childhood immunisations and teenage pregnancy.

5.1 Fertility

There are approximately 2200 births to Warrington women each year. Chart
5.1 shows that Warrington’s crude fertility rate has remained fairly constant
since 2000-2002, rates have increased only slightly in Warrington, by 1% from
2000-2002 to 2004-2006. In contrast, national and regional fertility rates have
experienced a steady increase. England’s fertility rate has increased 8%, the
North West fertility rate has increased by 7%.

Chart 5.1: Fertility Rate per 1000 Female Population Aged 15 - 44 Years

                                        Crude Fertility Rate per 1000 Female Population Aged 15 -44 Years.
                                               Three Year Rolling Averages 200-2002 to 2004-2006


     60.00


     59.00


     58.00


     57.00


     56.00


     55.00


     54.00


     53.00


     52.00


     51.00
                     2000-2002                    2001-2003            2002-2004               2003-2005        2004-2006
                                Warrington                                 North West                        England
    Data Source: Compendium of Clinical and Health Indicators




1
    Warrington PCT: CYP Health Needs Assessment, February 2007


                                                                                                                            59
The fertility age profile within Warrington has changed slightly over recent
years, with the percentage of older mums (aged over 35) increasing. In 2000
less than 17% of births were to women aged over 35, in 2006 21% of all births
were to older women. The proportion of births to young mums (aged under
20) has remained fairly constant at approximately 7%.

In 2006 the borough overall fertility rate was 56.3. This is lower than the
England rate of 60.3. Using our locally held public health birth files, a 2006
crude ward rate has been calculated for Warrington. Six wards within
Warrington had a fertility rate higher than the national figure. Bewsey &
Whitecross had the highest fertility rate of 73.4 births per 1000 15-44 female
population. Poplars and Hulme had the next highest rate of 69.8. Culcheth,
Glazebury and Croft experienced the lowest fertility rate in Warrington of 35.3.
Map 5.1 presents the distribution of fertility rates at ward level.


Map 5.1: 2006 Fertility Rate: Crude Rate per 1000 15-44 Female
Population




                                                                              60
5.2 Infant Mortality

Infant mortality, that is the death rate amongst babies less than one year old,
is used as an indicator of population health. It reflects socio-economic factors
and maternal health, and it can be used to compare the health and well-being
of populations across and within countries. Infant mortality forms part of the
governments plan to tackle health inequalities, with a 10% reduction in the
gap between rates in ‘routine’ and ‘manual’ socio-economic groups and
England as a whole required by 2010. Infant mortality is the second aspect of
the health inequalities PSA target and is a mandatory indicator for both PCT
and local government.

The number of infant deaths per year is very small. In 2006 there were 11
deaths amongst babies aged under one year in Warrington, this gave a rate of
4.9 per 1,000 live births. The rate in the borough is lower than the rate for
England (5.0 per 1,000 births) and the North West region (5.6 per 1,000
births). As with other health indicators, there is variation within Warrington,
however the very small number of deaths means it is not feasible to calculate
robust ward level rates, as even aggregating a number of years will still result
in very small numbers at this level.

In view of these issues, in order to monitor the health inequalities target at a
local level, it is necessary to look at other indicators of infant health. Low birth
weight is a useful indicator, and the Government has proposed two further
indicators which can be used as interim measures for the infant mortality
indicator; breastfeeding and smoking in pregnancy.

5.3 Low Birth Weight

The birth weight of a baby is considered to be low when the weight is below
2500 grams. Low birth weight is predictive of increased risk of ill health and
the incidence is linked to socio-economic and lifestyle (e.g. smoking) factors.
Information on all births to Warrington women is available locally from the
annual Public Health Birth File. From this data source the birth weight can be
obtained along with the area of residence at time of birth. Chart 5.2 illustrates
the trend in percentage of low birth weights. Within England as a whole the
percentage has remained fairly constant. Within Warrington, however, there
have been considerable fluctuations over the time period (1997 to 2006). The
latest low birth weight data (2004-2006) reports 6.5% of all births weighed less
than 2500gms, this is lower than both the national (7.8%) and regional figure
(8.2%).




                                                                                   61
Chart 5.2: Trend in Low Birth Weight Births 1997 to 2006

                                                                                               Percentage Low Birth Weights.
                                                                                      Three Year Rolling Averages, 1997-1999 to 2004-2006
                                                      9.0


                                                      8.5
    Percentage of births weighing less than 2500gms




                                                      8.0


                                                      7.5


                                                      7.0


                                                      6.5


                                                      6.0


                                                      5.5


                                                      5.0


                                                      4.5


                                                      4.0
                                                            1997-1999     1998-2000      1999-2001     2000-2002       2001-2003   2002-2004   2003-2005        2004-2006

                                                                        England                                North West                          Warrington

Data source: National Centre for Health Outcomes Development (NCHOD), 2007




5.4 Breastfeeding

The positive health benefits for breast fed children are well documented. In
2003, as a proxy indicator for infant health, the government set a target to
increase the number of women starting to breastfeed by 2% a year. Breast
milk contains the right amount of nutrients, in the right proportions, for the
growing baby. Evidence shows that breast milk has antibodies which protect
against infection – including gastroenteritis, respiratory illness, urinary
infections, and ear infections. In addition, it reduces the risk of childhood
diabetes and leukaemia, and of allergic conditions, such as asthma and
eczema. Research suggests that infants who are not breastfed are much
more likely to be admitted to hospital in their first year of life.

The government target set in 2003 for the NHS relates to increasing the
percentage of mothers initiating breastfeeding. From 2008 measures will be
in place to monitor continuation rates, with the aim of increasing prevalence of
breastfeeding at 6-8 weeks. This will be monitored through the new LAA.
Information on breastfeeding initiation is reported through the Local Delivery
Plan (LDP) process, and is available in aggregate form for comparative
purposes from the Department of Health2.


2

http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Maternalandinfantnutrition/DH_0
73254


                                                                                                                                                                            62
The average proportion of women breastfeeding on delivery in Warrington has
increased from 54% in 2002/03 to 58% in 2005/06. This compares with an
England average over the same period of 66.7% (based on aggregate data
from PCTs that submitted robust information). The latest data locally for
2006/07 indicate that the breastfeeding on delivery in Warrington has
decreased slightly to 56.6%.

5.5 Childhood Obesity

Childhood obesity is a Public Service Agreement (PSA) target set in July
2004, which aims to halt the year on year rise in obesity among children under
11 by 2010 in England3. In the summer of 2007 the heights and weights of
Warrington primary school children in Reception (aged 4 and 5) and Year 6
(aged 10 and 11) were measured and collated. These data were anonymised
and uploaded onto the National Childhood Measurement Programme
Database (NCMP). NCMP automatically calculates the Body Mass Index
(BMI) for each record. The 85th and 95th centile cut-offs from the British
Growth Reference 1990 were selected by the Department of Health as public
health definitions of overweight and obese children in the population
respectively.

The results from the data collection exercise should be used for indicative
purposes only, as due to the relatively small numbers, prevalence figures
calculated at a local level may not be statistically robust. Table 5.1 below
shows the percentage of Warrington pupils who had their heights and weights
recorded during 2006/07. Warrington achieved a higher percentage of pupils
with a height and weight recorded than the national average.


Table 5.1: Number of Pupils with Heights and Weights Recorded
                                         Warrington England
                 Numbers Number          Percentage Percentage
                 on Roll    measured Measured        Measured
 Reception       2209       2277         97%         83%
 St Year 6       1964       2394         82%         78%
 Warrington
 Overall         4173       4671         89%




Table 5.2 shows the summary provided by the NCMP for Warrington PCT.
The summary has separated overweight (85th – 94th centile cut off) and
obese (>=95th centile cut-off) children.
3
 Analysis of the National Childhood Database 2005-06: A Report for the Department of
Health by the South East Public Health Observatory on behalf of the Association of Public
Health Observatories


                                                                                            63
Table 5.2: Warrington PCT NCMP Summary

 1. Percentage of                       England                    England
 pupils with a BMI p-     Warrington Average          Warrington Average
 score:                   Reception     Reception Year 6           Year 6
 >=0.85 (defined as
 overweight)              13.6%         13.0%         13.8%        14.2%
 >=0.95 (defined as
 obese)                   9.8%          9.9%          15.9%        17.5%
Table 5.2 shows that obesity amongst Reception children in Warrington was
0.6% greater than the England average. However Warrington has below
average proportions of overweight reception children and obese and
overweight Year 6 children.

Using the children’s residential postcode, the heights and weights data were
ranked by ID 2007 national deprivation quintile. Warrington pupils who live in
the 20% most deprived Lower Super Output Areas (SOAs) nationally were
ranked in Quintile 1. Charts and tables presented here are based on children
who live within the borough of Warrington only. They therefore exclude
children who reside out of the borough but attend a school in Warrington.

Chart 5.3 shows the percentage of Reception children by national deprivation
quintile who were defined as either overweight or obese (BMI >=25) and those
who are defined as obese (BMI >=30).

Chart 5.3: Reception Data: Percentage Overweight & Obese and Obese.
Academic Year 2006/07
                   Percentage of Obese and Overweight Reception Children by National Deprivation Quintile.
                                                 Academic Year 2006/07


 30.0%




 25.0%




 20.0%




 15.0%




 10.0%




  5.0%




  0.0%
         Quintile 1- Most Deprived          Quintile 2        Quintile 3              Quintile 4          Quintile 5 - Least Deprived

                  Obese              Overweight & Obese    Warrington Overall Obese         Warrington Overall Overweight & Obese




The percentage of overweight and obese children in Warrington appears to be
comparable across all the deprivation quintiles. As previously mentioned,
these prevalence rates are based on small numbers and therefore care must


                                                                                                                                64
be taken when interpreting data. The highest proportion of obese Reception
children appears to be in Quintile 2, with 14.8% of the children regarded as
obese compared to the Warrington overall figure of 9.9%.

Chart 5.4 shows the percentage of overweight & obese Year 6 children in
Warrington. Overall there appears to be a greater proportion of overweight
and obese children in Year 6 compared to Reception year. This is reflected
nationally, the National Child Measurement Programme 2006/07 headline
results4 reported that the prevalence of obesity is significantly higher in Year 6
than Reception. Unlike the Reception data, the proportion of overweight
children appears to be related to deprivation, with overweight decreasing with
decreasing deprivation. In 2005/06, 39% of pupils in Quintile 1 were
overweight or obese, based on the 2006/07 data this has decreased slightly to
35%. Overweight & obesity prevalence is lower in quintile 5 at 25.8% but this
is slightly higher than 2005/06 data when 23% of pupils in quintile 5 were
overweight or obese.

Chart 5.4: Year 6 Data: Percentage Overweight & Obese and Obese.
Academic Year 2006/07
                         Percentage of Obese and Overweight Year 6 Children by National Deprivation Quintile.
                                                      Academic Year 2006/07


    40.0%


    35.0%


    30.0%


    25.0%


    20.0%


    15.0%


    10.0%


    5.0%


    0.0%
            Quintile 1- Most Deprived         Quintile 2          Quintile 3              Quintile 4          Quintile 5 - Least Deprived

                     Obese              Overweight & Obese     Warrington Overall Obese         Warrington Overall Overweight & Obese




4
 Department of Health: National Child Measurement Programme: 2006/07 school year,
headline results.


                                                                                                                                65
5.6 Children’s Health Related Behaviour

Information on children’s health related behaviour or lifestyle is not routinely
collected through any standard data source. Within Warrington, high schools
have been invited to take part in an online Healthy Schools questionnaire.
This is a self reporting survey which aims to obtain information on health
related issues such as diet, exercise, relationships, feelings and emotions. In
2006, 1606 pupils completed the survey the majority of the pupils were aged
13-15 years. The results of the survey are discussed below.

5.6.1 Diet
Pupils were asked a range of questions about their diet. They were asked to
indicate how often they consumed the recommended five portions of fruit and
vegetables per day. The Health Survey for England Update (2005) found that
16% of boys aged 14 years and 10% of girls aged 14 years ate more than five
portions of fruit and vegetables a day. This is significantly lower than
Warrington, with 39% of girls and boys in Warrington reporting that they ate
five portions of fruit and vegetables a day.
Pupils were asked to record what they had eaten for breakfast on the morning
of the survey. 44% of pupils stated that they had eaten breakfast that
morning; the majority (33%) had cereal.

5.6.2 Drugs, Alcohol and Tobacco
Pupils were asked if they had ever used or tried a range of drugs including
alcohol and tobacco. 37% of pupils had used or tried alcohol, 16% had tried
tobacco; 8% of pupils reported using or trying cannabis. Of those who had
tried alcohol, 45% of boys and 57% of girls reported to have drunk alcohol in
the last month. Pupils were asked "Have you ever drunk so much that it has
changed your actions?" 27% of pupils said alcohol had occasionally changed
their actions, 4% said on a daily basis alcohol changed their actions.

The pupils were asked if they currently smoked. 12% of pupils reported to
smoke more than just one a week, this is slightly higher than the National
Statistics 2006 survey findings which reported 9% of pupils aged 11-15 years
smoked at least one cigarette a week. However it must be noted that a
different age group were consulted in the national survey and so the results
are not directly comparable.

Pupils were asked how they got their cigarettes. 33% of pupils reported
obtaining their cigarettes from a shop, this is surprising considering that the
majority of pupils who answered the question were below the legal age to buy
cigarettes. 16% of pupils bought them from someone they knew and 16% of
pupils asked someone else to buy the cigarettes for them. This pattern is
reflected in the Department of Health survey "Smoking, drinking & drug use
among young people in England in 2002" , where the majority of children got
their cigarettes from shops, the next main source was from buying or being
given them from someone they knew or a friend.




                                                                              66
5.6.3 Feeling and Emotions
Pupils were asked what they worry about. They were given a variety of issues
which they could choose from. The majority of pupils, 54%, worried about
exams. Female pupils seemed to worry a lot more than males. Although
both genders worried about friends, relationships and how people perceived
them, these areas seem to concern females more, for example, 38% of
females worried about relationships compared to 19% of males and 49% of
females concerned with how they look compared to only 19% of males.

Pupils were asked who they would talk to about their worries. 45% said they
would talk to a friend, 40% would speak to a parent or carer, and 8% would
speak to a teacher.

5.6.4 Caring for Others
Pupils were asked: “Do you spend time in the home looking after someone
with a disability or an illness?” 13% of pupils stated that they did look after
someone, 27% of these pupils looked after a parent or carer with a disability
or illness and 27% look after a brother or sister. 46% said they looked after
someone else, the majority of these reported looking after one or both of their
grandparents.

The pupils were then asked whether if caring for someone affected them or
not and how this affected them. 25% felt they were affected by caring for
someone else. The main affects on the pupils who did care for someone was
that they felt tired and they felt that they did not have time for their friends.
11% of the pupils were worried and got upset and 5% felt they could not get
any help.

5.6.5 Exercise
Encouraging participation in sports and activities for children is a key aspect of
developing healthy lifestyles and positive participation in the community. This
will help to impact on levels of ill-health arising in adulthood. The Department
for Culture, Media and Sport (DCMS) and the Department for Children,
Schools and Families (DCSF) recommend that children should get 2 hours or
more of physical activity per week in school. Targets are set for local areas,
and children participating in sport is an indicator included in the new LAA.

Information is available regarding the percentage of pupils who participate in
at least 2 hours of high-quality PE and out of hours school sport in a typical
week from the Physical Education, School Sport and Club Links (PESSCL).
This information is used to measure progress against the government’s PSA
target “To enhance the take up of sporting opportunities by 5-16 year olds by
increasing the percentage of school children who spend a minimum of two
hours each week on high quality PE and school sport, within and beyond the
curriculum to 75% by 2006 and to 85% by 2008”.




                                                                                67
As a whole Warrington’s participation has increased year on year, and has
exceeded both of these targets.
The data for this indicator has been aggregated to ward level based on the
location of the school. Data for all maintained schools has been provided.
There is no Key Stage 3 or 4 data for the wards of Bewsey & Whitecross,
Fairfield & Howley, Great Sankey North, Latchford West, Poplars & Hulme,
Stockton Heath and Westbrook as there are no maintained secondary schools
located there.

Key Stage 1
With the exception of three wards, 100% of pupils at Key Stage 1 attending
schools in the Local Authority are participating in 2 hours of high quality PE
and out of hours (OOH) school sport in a typical week.
The exceptions are Fairfield & Howley (52%), Penketh & Cuerdley (80%) and
Rixton & Woolston (95%).

Key Stage 2
The percentage drops at Key Stage 2, with six wards failing to report 100%
participation in 2 hours of high quality PE/OOH school sport.
The wards dropping from 100% are Poplars & Hulme which sees a significant
drop to 59%, Orford to 86% and Lymm to 99%. Rixton & Woolston also
experiences a decrease from 95% to 88%. Fairfield & Howley, although
failing to reach 100% participation has experienced a 23% increase to 67%,
and Penketh & Cuerdley a 6% increase to 88%.

Key Stage 3
There is a significant improvement in the participation rate at Key Stage 3 as
only 2 schools fail to report 100% participating in 2 hours of high quality
PE/OOH school sport.

Key Stage 4
The percentage of pupils participating in 2 hours of high quality PE/OOH
school sport per week varies significantly at KS4. 6 schools report 100%
participation, whilst the remaining 6 secondary schools all report below 60%.

5.7 Childhood Immunisations

There is a schedule of immunisations that are given in infancy and early
childhood; these immunisations have helped to eradicate many of the
infectious diseases that have caused death or serious illness in the past. If
most children are immunised, the spread of infection in the community is
drastically reduced. However when immunisation uptake rates fall, the
disease can return, this has been experienced locally with the outbreaks of
mumps in winter 2004/05. Immunisation is most effective if the majority of the
population is immunised, this creates "herd immunity" and protects against
epidemics. To achieve herd immunity 95% of the population need to be
immunised, thus this is the national target uptake for the childhood
immunisations. Uptake rates are reported as part of the national Coverage of
Vaccinations Evaluated Rapidly (COVER) programme. Table 5.3 shows the


                                                                             68
percentage uptake for all children at their second birthday. With the exception
of Measles, Mumps and Rubella (MMR), Warrington has consistently
achieved an uptake rate of 94% or above for childhood immunisations.

Table 5.3: Warrington: Percentage Uptake at their 2nd Birthday
 Financial                                                                         Haemophilus              Meningitis
 Year         Diptheria           Tetanus      Pertussis       Polio      MMR      Influenzae B             C
 2003/04      95%                 95%          95%             95%        84%      95%                      95%
 2004/05      96%                 96%          96%             96%        84%      96%                      96%
 2005/06      95%                 95%          94%             94%        85%      95%                      94%
 2006/07      96%                 96%          96%             96%        88%      96%                      96%
Data Source: COVER Programme
Chart 5.5 compares Warrington’s MMR uptake rate with national and regional
uptake rates. Locally, nationally and regionally MMR uptake rates have been
steadily increasing since 2003/04. The latest financial year’s data shows that
Warrington’s rate has increased considerably from 83.8% in 2003/04 to 88.3%
in 2006/07. Although the 95% immunity target has not yet been met, uptake
of MMR in Warrington is higher than the North West (87.7%) and England
(85%).

Chart 5.5: MMR Uptake Rates 2003/04 to 2006/07
                  Percentage of Children Immunised with the MMR Vaccine by their Second Birthday.
                                          Financial Years 2003/04 to 2006/07
 90.0%



 88.0%



 86.0%



 84.0%



 82.0%



 80.0%



 78.0%



 76.0%



 74.0%
               2003/2004                    2004/2005                  2005/2006                    2006/2007

                     Warrington                          England                           North West SHA

Data Source: Warrington data: Locally held COVER data, National data: Health Protection Agency


5.8 Child Poverty


In addition to the main Indices of Deprivation described in section 2 of this
report, a supplementary measure has also been produced, looking specifically
at Income Deprivation Affecting Children (IDACI) and is a subset of the
Income Deprivation Domain.



                                                                                                                  69
Income Deprivation Affecting Children Index (IDACI)
This measure looks at the percentage of an SOAs’ children aged under 16,
who are living in families in receipt of Income Support or Income Based Job
Seekers Allowance, or families in receipt of Working Families Tax
Credit/Disabled Persons Tax Credit whose income is below 60% of median
before housing costs. Map 5.2 presents the distribution of income deprivation
affecting children within Warrington. The pattern is consistent with the overall
deprivation map, with children living in the inner wards of Warrington
experiencing higher income deprivation levels than the more rural outer areas
of Warrington. SOA’s in Birchwood and Burtonwood are also within the most
40% most deprived quintiles nationally.

Map 5.2: ID 2007:– Income Deprivation Affecting Children by SOA




More up to date information on benefit claimants can be used as an
alternative to IDACI. National statistics produce official labour market
statistics which are available online from National Statistics official Market
Labour Statistics (NOMIS). NOMIS define dependent children as those
aged less than 16 years, together with those aged 16 to 18 who are still in
full-time education, for whom additional benefit is paid. Working age is
defined as 16-64 years for males and 16-59 years for females.

The proportion of children who live in a household where out of work benefit
is received is shown in Table 5.4. The rate of Income Support/Pension
Credit and Job Seekers Allowance claimants in Warrington is lower than
both the regional and national rates. Warrington incapacity claimant rate is
lower than the North West. It must be noted that this data relates to a single



                                                                                 70
        point in time and provides a snapshot of claims at that point. Consequently
        the rates should be used for indicative purposes only.

        Table 5.4: Claimants with One or More Dependent Children per 100,000
        Working Age Population.
                                              Number             Income                                Job
                              Incapacity
            Number                            claiming           support             Number            seekers
                              benefit,
            claiming                          income             /pension            claiming job      allowance.
Area                          Rate per
            incapacity                        support            credit. Rate        seekers           Rate per
                              100,000
            benefit.                          /pension           per 100,000         allowance         100,000
                              Pop'n
                                              credit.            Pop'n                                 Pop'n
England    13770              41.2            602890             1804.1              77170             230.9
North
West       2480               58.5            87380              2062.4              9480              223.8
Warrington 50                 41.2            1520               1253.8              200               165.0
        Data source: Claimant data, NOMIS. Mid 2006 population estimates, National Centre for Health
        Outcomes Development (NCHOD), 2007


        5.9 Oral Health

        Dental epidemiological surveys are carried out annually by the NHS to
        examine oral health in children. The surveys are conducted according to
        quality standards established by the British Association of Community
        Dentistry (BASCD) on behalf of the Department of Health. Standardised
        examination techniques, examination conditions, diagnostic criteria and
        sampling methods ensure the data is comparable across the country.

        In the North West the process is overseen by the Dental Observatory, and is
        carried out for Warrington PCT by trained and calibrated examiners from
        Warrington Primary Dental Service (PDS) based at Garven Place. These
        studies have been carried out for 20 years, and the data produced assists in
        the planning of dental services locally. The aim of the surveys is to measure
        the prevalence of dental caries among children aged 5, 12, 14 and Year 6.
        This was done over a four year cycle. In recent years, access to secondary
        schools became more difficult so it was decided in 2004/2005 to examine
        Year 6 children.

        The dental health of the children is measured by recording the number of
        Decayed, Missing and Filled teeth and the average is known as the dmft (milk
        teeth)/DMFT (permanent teeth) index. The percentage of children affected by
        decay is also calculated. Once the survey is complete the data is submitted to
        the Dental Observatory for further checks and quality audit before being sent
        to the national centre.

        In 2001/2002 mean dmft in 5 year olds was 1.29, with 35% of 5 year olds
        affected by tooth decay. In 2005/2006 the mean dmft in 5 year olds increased
        by 19% to 1.545 with 39% of the children being affected by tooth decay. In
        Year 6, (10 and 11 year olds), mean DMFT in 2004/2005 was 0.73 with 33%

        5
         2005/06 data was based on a random sample of children due to a change in data collection
        method.


                                                                                                       71
of the children affected by tooth decay. More detailed ward analysis reported
in the Children and Young People’s Health Need Assessment 2007 showed
that DMFT/dmft followed the deprivation pattern in Warrington.

The 2007/2008 survey currently being collated is measuring the dental health
of special needs children in Warrington.

5.10 Teenage Conceptions

The national target for teenage conceptions is a reduction of 50% in the rate
of conceptions amongst girls aged under 18, by 2010.

From 1998 to 2004 there had been a 17.3% decrease in Warrington’s under
18 conception rate. However, the rate in 2005 increased by 7% to 43.8 per
1,000 population, which now means the percentage decrease from the 1998
baseline to 2005, is 10.1%.

As the annual rates are based on a small number of events; (an average of
approximately 155 per year) quite large fluctuations are apparent between
years, as Chart 5.6 illustrates. The small number of conceptions per year
means that the confidence intervals around the crude rate are quite large –
thus making the interpretation of rates and accurate analysis and projection of
trends difficult.

Chart 5.6: Annual Trend in Under 18 Conceptions – 1998 to 2005
                                                                 Trend in Teenage Conception Rates 1998 to 2005
                                                                  Warrington Rates with 95% Confidence Bands
                                                               showing England and North West rates for comparison



                                 60.0



                                 50.0
 Under 18 Teenage Conceptions
  per 1,000 Females aged 15-17




                                 40.0



                                 30.0



                                 20.0

                                                                                                                     England Rate

                                 10.0                                                                                North West Rate

                                                                                                                     Warrington Rate

                                  0.0
                                        1998 Baseline   1999           2000         2001         2002         2003   2004           2005




Aggregating data to three year averages evens out the annual fluctuations
and makes data more robust. Comparing the most recent three-year period
(2003-2005) with the earliest (1998-2000), there has been a decrease of
12.7% in Warrington. This is better than the decrease observed for England
as a whole (7.7%).


                                                                                                                                           72
Within Warrington, there is considerable variation in teenage conception rates,
and the pattern follows the pattern of deprivation, with inner wards having
much higher rates of teenage conceptions. Map 5.3 presents the variation in
teenage conception rates at electoral ward level in Warrington.

Map 5.3: Map Showing Ward Level Teenage Conceptions




5.11 Road Accidents

During the period 2001-2006 (the latest period for which there is validated
data) there has been a maximum of 20 accidents a year in Warrington
(average 17 per year), which resulted in a child killed or seriously injured.
Due to the small number of accidents the data has been suppressed from
mapping.

Analysis of the data shows that over the five years period all wards with the
exception of Great Sankey South have had at least one accident that has
resulted in a child being killed or seriously injured. Burtonwood & Winwick
and Woolston have been the location of the most accidents for the period.




                                                                                73
5.12 Hospital Admissions due to Injuries

Emergency admissions due to an injury in children aged 18 years and under,
were extracted from the PCTs inpatient dataset for the last five financial years
(ICD10 Codes V00-V99, W00-X59, X85-Y09). Chart 5.7 shows the crude rate
of children and young people admitted to hospital as a result of an injury by
age band, over the five financial years. Over the last two financial years all
age bands have seen a slight decrease in injury related admissions. Ages 15
to 18 years consistently have the highest emergency admission rates per
10,000 population. National and regional data were obtained from the North
West Public Health Observatory (NWPHO) who has access to national
Hospital Episodes Statistics (HES) data. Comparing local rates with national
and regional figures over the last five financial years, Warrington’s emergency
injury admission rates have been higher than the England and North West
rates. However the latest data show that the England emergency injury
admission rate has increased by 12% since 2002/03. In the North West the
rate has increased by 18%. In contrast Warrington’s rate has decreased by
3%. 2006/7 data indicates that Warrington’s rate has decreased, and is
slightly lower than the regional figures (1413 per 100,000, compared to 1474
per 100,000). Further trend analysis of subsequent years is required to
assess if the decrease in rates seen locally continues.

Chart 5.7: Emergency Hospital Admission Rates Caused by Injuries to
Children and Young People. April 2002 to March 2007.
                      Emergency Hospital Admissions Rates Caused by Injuries to Children and Young People.
                    ICD10 Codes V01 to Y98. Crude Rates per 10,000 Population. 1st April 2002 to 31st March 2007


 3000.00




 2500.00




 2000.00




 1500.00




 1000.00




  500.00




    0.00
                     2002/03                2003/04                  2004/05                     2005/06                  2006/07

           0 To 4              5 To 9      10 To 14       15 To 18             Warrington Rate             England Rate       North West




                                                                                                                                           74
5.13 Referrals to Social Care

Map 5.4 shows all child referrals to children’s social care between 01/04/06
and 31/03/07 in Warrington. The highest numbers of referrals are from
children living in the inner wards of Orford (230 referrals), Bewsey and
Whitecross (212), Poplars and Hulme (195) and Fairfield and Howley (192).
There are also relatively high numbers of referrals in Latchford East (141),
Poulton North (124) and Birchwood (119).

Other outer wards with over 50 to 100 referrals include Great Sankey South,
Lymm, Penketh and Cuerdley and Rixton and Woolston.

Hatton, Stretton and Walton ward has the lowest number of referrals (13).


Map 5.4: Number of Referrals/Child Screenings in Warrington from
01/04/06 – 03/03/07




                                                                               75
5.13.1 Children in Need
Children are classified as a ‘child in need’ and are given a children’s social
care team allocation based on the following criteria:
   • being unlikely to achieve or maintain, or have the opportunity of
       achieving or maintaining, a reasonable standard of health or
       development without the provision for him/her of services by a local
       authority;
   • having health or development likely to be significantly impaired, or
       further impaired, without the provision for him/her of such services; or
   • being disabled.

Map 5.5 illustrates total numbers of children in need by ward in March 2007.
Numbers are greatest in the inner wards of Orford, Latchford East and
Bewsey and Whitecross. There are also significant numbers in Fairfield and
Howley, Poplars and Hulme and Poulton North. The only outer ward with
relatively high numbers of children in need is Birchwood.


Map 5.5: Total Number of Children in Need by Ward in March 2007.




                                                                                  76
5.13.2 Children on the Child Protection Register
A child is placed on the Child Protection Register if there are significant
concerns, or actual harm has occurred, to that child. A child protection plan is
then put in place with the family to ensure the child is kept safe and has the
opportunity to reach their potential. There were 96 children on the Child
Protection Register on the 31st March 2007. Due to the small number of
children involved the data has been suppressed from mapping.

Analysis of the data shows that registrations are concentrated around the
inner wards of Bewsey & Whitecross, Orford, Poplars & Hulme and Poulton
North. 65% of the children registered are located within these wards.

One SOA located in Orford has the greatest number of children registered,
with over 15% of the total registrations located in this area.

In contrast there are 12 Wards with no resident children who were placed on
the Child Protection Register.

5.13.3 Looked After Children
A child becomes looked after if circumstances prevent that child from living
with its parents and the local authority takes responsibility for that child, or if
legal orders are put in place granting parental responsibility to the local
authority. There were 173 children looked after on the 31st March 2007. Due
to the small number of children involved the data has been suppressed from
mapping.

Analysis of the data shows that the majority of the children looked after
originated from the inner wards of Bewsey & Whitecross, Latchford East,
Orford, Poplars & Hulme and Poulton North. 69% of the total number of
looked after children come from these wards.

The SOAs with the greatest number of children looked after were located in
Poulton North (7.5% of total) and Poplars & Hulme (6.5% of total).

There are 7 wards where none of the children looked after on the 31st March
2007 originated from (Burtonwood & Winwick, Whittle Hall, Great Sankey
North, Latchford West, Stockton Heath, Rixton & Woolston and Hatton,
Stretton & Walton).

5.14 Young People Not in Education, Employment or Training
(NEET) aged 16 to 18

A measure is taken of the number of young people, aged 16 – 18, who have
finished statutory education and are not in employment, education or training
(NEET). This is a useful indicator to show if they are not constructively
participating in society, and are therefore less likely to achieve positive
outcomes for their futures.




                                                                                  77
The data is expressed as the percentage of NEET 16 – 18 year olds in a
ward, by the 16 – 18 population in that ward.
Map 5.6 illustrates that the percentage of 16 to 18 years olds not in Education,
Employment or Training is heavily concentrated in the wards of Bewsey &
Whitecross, Latchford East and Orford.

Latchford West, Poplars & Hulme, Poulton North and Birchwood also have
numbers of 16 to 18 years olds who are classed as NEET that are higher than
the Warrington average.

When the data is analysed by SOA there is direct correlation between the
indices of deprivation and the number of NEET in the area. All areas where
there are 10 or more young people who are NEET, are ranked in the 30%
most deprived areas.

Hatton, Stretton & Walton, Grappenhall & Thelwall, Lymm, Penketh &
Cuerdley and Stockton Heath all have less than 5 young people who are
NEET in the ward. The data has been suppressed due to small numbers.
Within these wards all SOAs have less than 3 people per area classed as
NEET.

Map 5.6: Percentage of NEET per 16-18 population by Ward.




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5.15 Educational Attainment

Education is an important indicator of socio-economic status and influences
health inequalities in several ways. Educational achievement is closely related
with occupational level and income, and so affects the chances of
unemployment and poverty, both of which are known to negatively impact on
health. Low levels of educational attainment are most likely to occur among
children living in socially deprived areas. Schools also have an influence on
health related behaviour, such as smoking, drinking, drugs, exercise, diet and
safe play areas for children. Reducing the gap in school performance and
improving the health and social context of schools are therefore important
tenets in tackling both health and socio-economic inequalities.
Information was obtained from Children’s Services, Warrington Borough
Council on the following indicators:
   •   Foundation Stage
   •   Key Stage 1
   •   Numeracy and literacy skills at Key Stage 2 Standard Assessment
       Tests (SATs)
   •   GCSE pass rates and grades


5.15.1 Total Score for Pupils at Foundation Stage by Ward
Children at Foundation Stage (aged 3-5) are tested on 13 different factors
(including 'Personal, Social and Emotional Development', 'Mathematical
Development' and 'Communication, Language and Literacy') each with a
score of up to 9 points, giving a maximum overall score of 117. Map 5.7
illustrates the ward average for total point score for pupils at Foundation Stage
(children aged 3 – 5).

The average for Warrington is 91.3 points and 12 of the wards have scored
higher than this average.

Bewsey & Whitecross and Poplars & Hulme both report a significantly lower
score than the average. These wards are both in the 30% most deprived
according to the 2007 Indices of Deprivation. The remaining wards that are
ranked as most deprived, also have a lower than average point score for the
Foundation Stage.

Children resident in the wards of Lymm, Appleton and Stockton Heath report
the highest average point score at Foundation Stage.




                                                                               79
Map 5.7: Total Score for Pupils at Foundation Stage in Warrington by
Ward.




                                                                       80
5.15.2 Key Stage 1 2006
Pupils are assessed by their teachers at the end of Key Stage 1, when they
are 7 years old. The main indicator of performance is the percentage of pupils
achieving Level 2 or above in the teacher assessments in maths, reading and
writing.

Maths: Map 5.8 illustrates Level 2 or above in maths based on the pupil’s
postcode of residence. Warrington as a whole performs well in Key Stage 1
Maths. The average percentage achieving Level 2 or above is 93.5%
compared to 90% for England. There are, however areas which perform less
well. Whilst two thirds of the wards are above the Warrington average, a
handful of wards performed relatively poorly.

In Bewsey and Whitecross, 77% of pupils achieved Level 2 or above. Other
low percentages are found in Orford (89%), Poplars and Hulme (89%) and
Poulton North (91%). A number of outer wards also perform just below the
Warrington average. These are Burtonwood and Winwick (92%), Penketh and
Cuerdley (93%) and Rixton and Woolston (93%). By contrast, many other
outer wards are performing well above the average, with 100% of Hatton,
Stretton and Walton pupils achieving Level 2 or above.

Map 5.8: Pupils achieving Level 2 or above at Key Stage 1 Maths by
Ward.




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Reading: Warrington also performs well in terms of pupils reading
achievements with an average of 88% attaining Level 2. The average
percentage in England is 84%. Orford, Poplars and Hulme and Latchford East
perform least well, and just 74% of pupils in Bewsey and Whitecross achieve
Level 2 and above.

Pupils resident in Birchwood and Stockton Heath achieve around the average
for Warrington, whilst most of the outer wards with the exception of
Burtonwood and Winwick are well above the average. The best performing
wards are Westbrook, Appleton and Hatton, Stretton and Walton, the latter
again achieving 100% Level 2 or above in reading.

Map 5.9: Pupils achieving Level 2 or above at Key Stage 1 Reading by
Ward.




                                                                         82
Writing: Map 5.10 illustrates achievement at Level 2 or above in writing
based on the pupil’s postcode of residence. Warrington as a whole performs
well in Key Stage 1. The average percentage achieving Level 2 or above in
writing is 86.4% compared to 81% for England. There are however, areas
which perform less well. As with other areas of Key Stage 1 assessment, two
thirds of the wards are above the Warrington average, whilst seven perform
relatively poorly.

In Orford, 71% of pupils achieved Level 2 or above. Other low percentages
are found in Bewsey and Whitecross (73%), Poplars and Hulme (77%) and
Latchford East (79%). A number of outer wards perform in line with or within
two percentage points of the Warrington average. These are Stockton Heath
(86%), Poulton South (87%), Culcheth, Glazebury and Croft, Penketh and
Cuerdley and Rixton and Woolston (all 88%). Many other outer wards are
performing well above this average, with 95% of Appleton ward and Hatton,
Stretton and Walton ward pupils achieving Level 2 and above.

Map 5.10: Pupils achieving Level 2 or above at Key Stage 1 Writing by
Ward.




                                                                               83
5.15.3 Key Stage 2 2006
Pupils are assessed by a series of tests at the end of Key Stage 2, when they
are 10 to 11 years old. Performance is measured by the percentage of pupils
achieving level 4 or above in each subject. Warrington as a whole performs
well at Key Stage 2, and is above England averages in all subjects.

Maths: Map 5.11 illustrates the percentage of pupils achieving level 4 at Key
Stage 2 tests in maths by ward. 13 wards report scores higher than the
Warrington average (82%) and a further two higher than the England average
(76%).

Latchford East and Orford have the lowest percentage of children achieving
level 4 in maths. None of the SOAs in either of these wards achieved above
the Warrington average.

Pupils resident in the wards of Hatton, Stretton & Walton, Culcheth, Glazebury
& Croft and Appleton are the highest achievers. These wards are performing
well above the average for Warrington.

Map 5.11: Pupils achieving Level 4 or above at Key Stage 2 Maths by
Ward.




                                                                             84
The worst SOA, at 37.5%, is located in Fairfield and Howley. This SOA is
ranked in the 30% most deprived according to the 2007 Indices of
Deprivation. Latchford East, Poulton North and Birchwood also have a super
output area where the performance is below 50%. However, there are some
of poorly performing SOAs outside of the inner wards. Care should be taken
when interpreting results at SOA level, as rates may be based on quite small
numbers.

Map 5.12: Pupils achieving Level 4 or above at Key Stage 2 Maths in
Warrington by SOA.




                                                                           85
English: Map 5.13 presents the percentage of pupils achieving level 4 at Key
Stage 2 tests in English by ward. The Warrington average is 82%. 14 wards
report a higher than Warrington average percentage. The England average is
79% and 15 wards report higher than this.

The lowest performing wards are Orford and Poplars & Hulme. Both wards
have less than 70% of pupils in achieving level 4 in English.

Map 5.13: Pupils achieving Level 4 or above at Key Stage 2 English in
Warrington by Ward.




The worst performing SOA is in the Birchwood ward, which is outside of the
inner Warrington area. Only 41.2% of this SOA’s resident pupils attained
Level 4 or above. Poulton North also has an SOA where the performance is
below 50%. These SOAs are not considered to be in the 30% most deprived
areas according to the 2007 Indices of Deprivation. In contrast Birchwood and
Poulton North also have SOAs where 100% of children achieved level 4 in
KS2 English. This is illustrated in map 5.14




                                                                           86
Map 5.14: Pupils achieving Level 4 or above at Key Stage 2 English by
SOA.




                                                                        87
Science: Performance in Warrington is very good for this indicator. Map 5.15
presents the percentage of pupils achieving level 4 at Key Stage 2 tests in
science by ward. 12 wards report achievements higher than the Warrington
average (90.7%) and a further 4 higher than the England average (87%).

Orford, Poplars & Hulme, Latchford East and Fairfield & Howley have the
lowest percentage of children achieving level 4 in science by ward. All of
these wards however, are reporting more than 80% achievement.

Map 5.15: Pupils achieving Level 4 or above at Key Stage 2 Science by
Ward.




                                                                             88
With the exception of one, every SOA in Warrington has reported above 60%
achievement of Level 4 in science. The exception is located in Fairfield &
Howley where achievement is 37.5%. This SOA is ranked in the 10% most
deprived in the 2007 Indices of deprivation.

36 SOAs are reporting 100% achievement of level 4 or above in science.
60% of SOAs report achievement of above the Warrington average and 72%
of SOAs achieved higher than the England average. Map 5.16 illustrates SOA
level results.

Map 5.16: Pupils achieving Level 4 or above at Key Stage 2 Science by
SOA.




                                                                         89
5.16: Key Stage 4 2006

Warrington performs well as an authority at Key Stage 4. As with all SOA
analysis there are some low numbers and some caution should be exercised
when analysing the information. Generally the outer wards of Warrington
perform well. The majority of south Warrington has over 70% of pupils
achieving 5 or more GCSEs grades A* - C, apart from two SOAs in Stockton
Heath and Appleton. Much of the west of the borough performs well apart
from SOAs in the Great Sankey North and South wards, and all of Bewsey
and Whitecross. The outer part of Rixton and Woolston and northern part of
Culcheth, Glazebury and Croft have SOAs where resident pupils achieve
fewer 5 A*-C grades. Map 5.17 presents results at SOA level.

Map 5.17: Percentage of pupils achieving 5 or more GCSEs A* - C by
SOA.




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