School-aged Children

School-aged children represent approximately 18% of the population in Bury. Measuring and reporting on health and well-being of this group is crucial to improve their health outcomes by identifying potential issues, examining trends and developing targeted evidence-based intervention. Office for Health Improvement and Disparities (OHID) presents detailed indicators on school-aged children health and well-being in the Child and Maternal Health profiles. The benefit of examining these indicators lies in early detection of health problems, allowing for timely interventions. By identifying areas where interventions can have the greatest impact, such as high rates of obesity in Reception and Year 6 children, low vaccination rates, effective evidence-based strategies can be developed and implemented. Additionally, examining changes in these indicators helps evaluate the effectiveness of existing policies and interventions, further enabling evidence-based decision-making and modification of interventions if needed. Furthermore, examining public health indicators in school-aged children contributes to addressing health inequalities and disparities, promoting health equity for all.

Child Poverty

The Marmot Review (2010) suggests there is evidence that childhood poverty leads to premature mortality and poor health outcomes for adults. Reducing the numbers of children who experience poverty should improve these adult health outcomes and increase healthy life expectancy. There is also a wide variety of evidence to show that children who live in poverty are exposed to a range of risks that can have a serious impact on their mental health. The Department for Work and Pensions has a statutory obligation to publish a measure of relative and absolute low income and low income and material deprivation for children under section 4 of the Welfare Reform and Work Act 2016.

Children in absolute low income families (under 16s)

The children in absolute low income families measure is useful for tracking changes over time in relation to a fixed reference point and is designed to assess how low incomes are faring with reference to inflation. This indicator measures the percentage of children (under 16 years) in a local area, living in absolute low income families. A family is defined as a single adult, or a married or cohabitating couple, or a Civil Partnership and any dependent children.

Equivalised income is income Before Housing Costs (BHC) and includes contributions from earnings, state support and pensions. Equivalisation adjusts incomes for family size and composition, taking an adult couple with no children as the reference point. Absolute low income is defined as a family in low income Before Housing Costs (BHC) in the reference year in comparison with incomes in 2010 to 2011. A family must have claimed one or more of Universal Credit, Tax Credits or Housing Benefit at any point in the year to be classed as low income in these statistics. Absolute low income takes the 60 percent of median income threshold from 2010 to 2011 and then fixes this in real terms (i.e. the line moves with inflation). This is designed to assess how low incomes are faring with reference to inflation. It measures the number and proportion of individuals who have incomes below this threshold. The percentage of individuals in absolute low income will decrease if individuals with lower incomes see their incomes rise by more than inflation (Child and Maternal Health Profiles, 2024).

Based on the most recent data from 2022/23, 20.5% of children under 16 years of age are in absolute low income families, higher (statistically significant) to the England average of 15.6%. The percentage in Bury has fluctuated over time, ranging from 18.6% in 2014/15, to reaching its lowest level in 2021/22 at 16%, followed by its peak at 20.5% in 2022/23. The rate in England meanwhile has remained relatively stable, increasing slightly from 15.4% in 2014/15 to 15.6% in 2022/23 (Figure 1). The rate in Bury has remained significantly worse than that in England for the observed time period.

Figure 1: Proportion of children in absolute low income families for Bury and England from the year 2014/15 to 2022/23 (Child and Maternal Health, 2023)

When compared with Bury’s statistical neighbours, Bury has the highest percentage of children living in absolute low income families for 2022/23 with the lowest percentage in Stockport of 13.2% (Child and Maternal Health Profiles, 2023). There are no data on inequalities at Bury level, but at England level the data suggest higher proportions of children living in absolute low income families as the level of deprivation increases. The highest percentage of children living in absolute low income families is in the second most deprived decile (40.4%), followed by the most deprived decile (38.4%), whereas the lowest percentage is in the second least deprived decile (3.9%) followed by the least deprived decile (6.4%) for 2022/23 (Child and Maternal Health Profiles, 2023).

Children in relative low income families (under 16s)

The children in relative low income families measure is useful for comparing the situation in local areas and measuring the number and proportion of individuals who are currently in low income compared to the current median income. Relative low income is defined as a family in low income Before Housing Costs (BHC) in the reference year. A family must have claimed one or more of Universal Credit, Tax Credits or Housing Benefit at any point in the year to be classed as low income in these statistics.

Relative low income sets a threshold as 60 percent of the UK average (median) income and moves each year as average income changes. It is used to measure the number and proportion of individuals who have income below this threshold. The percentage of individuals in relative low income will decrease if:

• Average (median) income stays the same or rises and individuals with lower incomes see their incomes rise more than the average, or
• Average (median) incomes fall and individuals with lower incomes see their incomes fall less than average incomes (Maternal and Child Health Profiles, 2023).

Based on the most recent data from 2022/23, 26.7% of children under 16 years of age are in relative low income families, higher (statistically significant) than the England average of 19.8% (Maternal and Child Health Profiles, 2023). The proportion in Bury has increased gradually over time from its lowest figure of 18.7% in 2014/15, to its highest figure of 26.7% in 2022/23. Bury has remained significantly worse than England in this measure for the observed time period and there is an increasing and getting worse trend (statistically significant). The percentage has also increased across England, although at a slower rate, as it increased from 15.3% in 2014/15 to 19.8% in 2022/23 (Figure 2).

Figure 2: Proportion (%) of children in relative low income families (under 16s) for Bury and England from the year 2014/15 to 2022/23 (Child and Maternal Health, 2023)

Bury has the highest percentage of children living in relative low income families compared to its statistical neighbours for 2022/23, with the lowest percentage in Stockport of 17.6% (Maternal and Child Health Profiles, 2023). There are no data on inequalities at Bury level, however the data at England level suggests the percentage of children living in relative low income families increases as the level of deprivation increases. The highest percentage of children living in relative low income families is 50.1% in the second most deprived decile, followed by 48.5% in the most deprived decile and the lowest percentage is 5.1% in the second least deprived decile, followed by 7.6% in the third least deprived decile and 7.8% in the least deprived decile for 2022/23 (Maternal and Child Health Profiles, 2023).

Free school meals: % eligible among all pupils

This indicator provides insights into child poverty and serves as a proxy for socioeconomic disadvantage among school-aged children. It is defined as the percentage of pupils known to be eligible for free school meals who attend a state funded nursery, primary, secondary, alternative provision and special schools and non-maintained special schools.

The most recent data on eligibility of free school meals are for 2023/24, where the figure in Bury was 23.7%, lower (statistically significant) than the England average of 24.6%. The trend data based on 5 most recent data points suggests that the free school eligibility in Bury is increasing and the gap (%) compared with England has remained relatively stable. Free school eligibility was similar to the England average for 2014/15 (15.3% in Bury vs 15.2% in England) and 2020/21 (20.9% in Bury vs 20.8% in England) but was above England’s average (statistically significant) throughout the period 2015/16 to 2019/20. Free school eligibility has increased gradually from 16.1% in 2018/19 to 23.7% in 2023/24 in Bury and from 15.2% to 24.6%in England for the same time period. For the last three time periods, Bury has been significantly lower (statistically significant) than England in this measure (Figure 3).

Figure 3: Proportion (%) eligible of free school meals among all pupils for Bury and England from 2014/15 to 2023/24 (Child and Maternal Health, 2024)

Bury has the second lowest percentage eligible for free school meals among all pupils in its group of six statistical children service neighbours, with the lowest percentage in Stockport at 20.8% and highest in Stockton-on Tees at 27.7% (Child and Maternal Health, 2024). Data on inequalities for Bury are unavailable. Examining data at England level by deprivation suggests increasing % eligibility of free school meals among all pupils with increasing levels of deprivation. The most deprived decile in England has 36.3% of children eligible, compared with 14.5% in the least deprived decile for the year 2023/24 (Child and Maternal Health, 2024).

Child Mortality

Death in childhood represents not only a tragedy for that child’s family but also a loss to wider society in terms of lost years of productive life. Once children reach the age of one, injuries become the most common cause of death. It is important to acknowledge that many of these deaths resulting from injuries could be prevented. Furthermore, there is a recognised need to offer sufficient support to children and families facing life-limiting or life-threatening conditions.

Child mortality is presented as a directly standardised rate of death due to all causes, per 100,000 population aged 1-17 years. The child mortality data for Bury reveals that the child mortality rate stands at 13.6 per 100,000 for 2021-23, which is statistically similar to the England average of 11.2 per 100,000 (Child and Maternal Health Profile, 2023).

Figure 4 below presents the trend in child mortality rate in Bury.

Figure 4: Directly standardised rate of death due to all causes, per 100,000 population aged 1-17 years in Bury and England from the period 2010-12 to 2021-23 (Child and Maternal Health Profile, 2023).

During the period from 2010 to 2012, the child mortality rate in Bury was recorded at 14.6 per 100,000 population aged 1-17 years. However, in subsequent years, there has been a decline in child mortality rates in Bury, with a decrease to 10 per 100,000 population in 2016-18. Following this, the rates fluctuated with the most recent data point indicating a rise to a rate of 13.6 per 100,000 population in 2021-23.

In comparison, the average child mortality rate for England exhibited a gradual decrease over the same period, with a slight dip in 2012-14 but showing consistent decline thereafter up until 2019-21, which was then followed by two periods of increase to 11.2 per 100,000 for 2021-23. The trend in Bury has remained statistically similar to the England child mortality rate for the observed time period (Child and Maternal Health Profile, 2023).

There are no available data at local levels to examine inequalities in Bury but data for England suggests inequalities by deprivation, with higher child mortality in the most deprived decile (15 per 100,000) compared with the least deprived decile (8.6 per 100,000) for 2021-23 (Child and Maternal Health Profile, 2023). Data at England level are also available by sex, which shows higher child mortality rates amongst males (12.8 per 100,000) compared to females (9.6 per 100,000) for 2021-23 (Child and Maternal Health Profiles, 2023).

Immunisation Coverage

Immunisation coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases. Coverage is closely correlated with levels of disease. Monitoring coverage identifies possible drops in immunity before levels of disease rise. Previous evidence shows that highlighting vaccination programmes encourages improvements in uptake levels.

Data on immunisation for school-aged children are publicly available for Human Papilloma Virus (HPV) vaccine (one dose at 12-13 years and two doses 13-14 years) and Meningococcal ACWY conjugate vaccine (MenACWY) at 14-15 years of age. For HPV vaccine, we will present data on one dose only as the JCVI has advised move to 1 dose of HPV vaccine for adolescents. JCVI has stated that 1 dose of the vaccine is just as effective as 2 at preventing cancers caused by HPV in adolescents. Immunisations during the early years are available under the early years section of Starting Well in the Bury JSNA.

Human Papilloma Virus (HPV) Vaccine

HPV is a common infection that is spread by skin-to-skin contact, including sexual contact, which can lead to the development of cancers affecting both women and men, including the cervix, vulva, vagina, penis, anus and oral cavity.

On the advice of the Joint Committee on Vaccination and Immunisation (JCVI), an HPV national vaccination programme was introduced in 2008, to protect adolescent females against cervical cancer. From September 2019, 12 to 13 year old males became eligible for HPV immunisation alongside females, based on JCVI advice. This was the first year that males in year 9 were offered the HPV vaccine (OHID, 2024).

Research has shown that in England cervical cancer has almost been eliminated among young women who were offered the HPV vaccine (NIHR, 2022).

Population vaccination coverage: HPV vaccination coverage for one dose (12 to 13 year old) (Female)

HPV vaccination coverage in Bury for one dose in females aged 12-13 years for the period 2023/24 is at 67.4%, lower (statistically significant) than the England average of 72.9% (Child and Maternal Health, 2024). Bury would have needed to vaccinate 265 additional females aged 12-13 years to reach the national target of 90% or higher in 2022/23.

Examining trend data for Bury from 2013/14 to 2023/24, there is a slight decrease in HPV vaccination coverage from 88.8% in 2013/14 to 85.7% in 2014/15. The coverage remains relatively stable in 2015/16 at 87%. This is followed by a drop in 2016/17 to 76.1%. The coverage then increases in 2017/18 to 79.4% and further improves in 2018/19 to 86.5%. It experiences a decline in 2019/20 to 78% but coverage has increased over the following two data points from 81.8% in 2020/21 to 84.7% in 2021/22, however this was followed by another period of decline to 79.4% in 2022/23 and 67.4% in 2023/24. Throughout this period, Bury coverage has not met the national target of 90%.

England saw a gradual decline in HPV vaccination coverage (one dose) for females from 91.1% in 2013/14 to 86.9% in 2017/18. Coverage then remained fairly stable at 88% in 2018/19. There was a large drop in vaccination coverage in 2019/20, where it declined to 59.2% followed by an increase to 76.7% in 2020/21. The data from 2021/22 shows another decline to 69.6%, followed by a slight increase to 71.3% in 2022/23 and 72.9% in 2023/24 (Figure 5).

Figure 5: Proportion of HPV vaccination coverage for one dose (12 to 13 year old) (Female) for Bury and England from the period 2013/14 to 2023/24 (Child and Maternal Health, 2024)

Bury has the 3rd lowest coverage amongst its group of 16 statistical service neighbours with the highest in Stockport at 88.3% and lowest in Rochdale at 65.4% for 2023/24(Child and Maternal Health, 2024).

Data on inequalities for Bury are only available by Sex. As we are presenting data on HPV vaccinations by males next, this comparison will not be presented here. Data on deprivation are only available at England level and suggest decreasing levels of HPV vaccination coverage as levels of deprivation increase. Coverage in the most deprived decile was 60.8% for 2023/24, compared to 81.1% in the least deprived decile (Child and Maternal Health, 2024).

There are no geographical, PCN or GP level data present for the HPV vaccine.

Population vaccination coverage: HPV vaccination coverage for one dose (12 to 13 year old) (Male)

HPV vaccination coverage in Bury for one dose in males aged 12-13 years for the period 2023/24 is at 58.6%, lower (statistically significant) than the England average of 67.7% and not meeting the national target of 90% and over (Child and Maternal Health, 2023). Bury would have needed to vaccinate 424 additional males aged 12 to 13 years to reach the national target in 2023/24.

Examining trend data for Bury from 2019/20 (when HPV vaccines for males were recommended) to 2023/24, HPV vaccination coverage increased from 59% in 2019/20 to 73.7% in 2020/21. This was followed by a decline from 69.9% in 2021/22 to 58.6% in 2023/24. There has been no significant change in trend for Bury but from 2019/20, coverage in Bury has remained lower (statistically significant) compared to England average.

England saw a similar trend with coverage increasing from 54.4% in 2019/20 to 71% in 2020/21. Similar to Bury, there was a decrease in coverage to 62.4% in 2021/22, followed steady increase to 65.2% in 2022/23 and 67.7% in 2023/24 (Figure 6).

Figure 6: Proportion of HPV vaccination coverage for one dose (12 to 13 year old) (Male) for Bury and England from the period 2013/14 to 2023/24 (Child and Maternal Health, 2024)

Bury has the lowest coverage in its group of statistical neighbours with the highest in Stockport at 84.3% for 2023/24 (Child and Maternal Health, 2024).

Data for Bury are only available by sex, however data at England level by deprivation again suggests levels of coverage decrease as the level of deprivation increases. Coverage for males was 54.5% in the most deprived decile for 2023/24, compared to 76.7% in the least deprived decile (Child and Maternal Health, 2024).

There are no geographical, PCN or GP level data present for the HPV vaccine.

Meningitis ACWY

The MenACWY vaccination was introduced into the national immunisation programme in autumn 2015, in response to a rapid and accelerating increase in cases of invasive meningococcal group W (MenW) disease, which was declared a national incident. The MenACWY conjugate vaccine provides direct protection to the vaccinated cohort and, by reducing MenW carriage, also provides indirect protection to unvaccinated children and adults. This follows advice from the Joint Committee on Vaccination and Immunisation (JCVI). It is routinely offered through schools in academic school Years 9 and 10 (rising 14 and rising 15 year olds).

Population vaccination coverage: Meningococcal ACWY conjugate vaccine (MenACWY) (14 to 15 years)

This indicator measures local authority level MenACWY vaccine coverage for pupils at the end of school Year 10. For the year 2023/24, Bury has a vaccination coverage of 72.6%, similar to the England average of 73%. The coverage in Bury is below the target of 90% and over. In 2023/24, Bury needed to vaccinate 430 additional children to reach the national target (Child and Maternal Health, 2024).

Examining trend data for Bury, immunisation coverage increased from 62.5% in 2016/17 to a peak of 96.1% in 2019/20. This was followed by a period of decline from 82.5% in 2020/21 to 66.8% in 2022/23. The latest time period 2023/24 shows a slight increase to 72.6%, but still significantly below the target of 90%.

The coverage in England increased from 82.5% in 2016/17 to its peak at 87% in 2019/20. This was followed by a steady decline in coverage from 80.9% in 2020/21 to 73% for 2023/24 (Figure 7).

Figure 7: Proportion (%) of Meningococcal ACWY conjugate vaccine (MenACWY) (14 to 15 years) coverage for Bury and England from the period 2016/17 to 2023/24 (Child and Maternal Health, 2024)

Bury has the fifth lowest coverage in its group of 16 statistical neighbours with the highest in Rochdale at 97.7% and lowest in Telford and Wrekin at 56.9% for 2023/24 (Child and Maternal Health, 2024).

There are no data on inequalities at Bury level, but England data suggests decreasing coverage of MenACWY vaccine with increasing levels of deprivation. The most deprived decile in England has a coverage of 61.1% compared with 81.8% in the least deprived decile for the year 2023/24 (Child and Maternal Health, 2024).

There are no geographical, PCN or GP level data present for the Meningococcal ACWY conjugate vaccine.

Emergency care

This section provides data on emergency cases requiring immediate attention for school-aged children in Bury. This data assists in identifying gaps in care, effective resource allocation, assessment of management of diseases, informing prevention efforts and evaluating healthcare services.

Common causes for emergency hospital admissions in school-aged children often include respiratory ailments like asthma and pneumonia, which can make children susceptible to infections. Certain chronic conditions like diabetes and epilepsy may require hospitalisation for effective management and monitoring.

Accidental injuries resulting from falls and mishaps, leading to fractures and head trauma, also contribute significantly. Moreover, mental health concerns, including self-harm and contemplation of self-harm, have emerged as key issues, highlighting the necessity for comprehensive support and assistance. Admissions from injuries and mental health concerns will be presented in their relevant sections.

Emergency admissions (aged under 18 years)

Emergency admissions for children and young people under 18 years of age are available as crude rate per 1,000 population aged under 18 years.

In 2023/24, the rate of emergency admissions for children and young people under 18 in Bury was 46.7 per 1,000 population, which is statistically better than the England average of 69.1 per 1,000. This represents a significant improvement from 2022/23, when the rate in Bury was 70.0 per 1,000, closely aligned with the national rate of 70.2 per 1,000 (Child and Maternal Health Profile, 2024).

Bury has the lowest rate of emergency admissions in its group of six statistical children service neighbours, with the highest rate in Stockton-on-Tees at 105.7 (Child and Maternal Health, 2024).

Inequality data for emergency admissions among children and young people in Bury are currently available by sex only. In 2023/24, rates were similar for both males and females, with 46.7 per 1,000 for males and 46.5 per 1,000 for females. Both figures are statistically comparable to the overall Bury average, indicating no significant difference in emergency admission rates by sex (Child and Maternal Health, 2024). England data are available by sex and levels of deprivation. Males aged under 18 years in England have a higher admission rate (72.6 per 1,000) compared with females (64.7 per 1,000) for 2023/24. Data by deprivation based on LSOA deprivation deciles suggests a deprivation gradient with increasing emergency admission rates with increasing levels of deprivation. The most deprived decile in England has an admission rate of 81.4 compared with 52.3 in the least deprived decile for the year 2023/24 (Child and Maternal Health, 2024).

A&E attendances (under 18 years)

A&E visits among children and young individuals under the age of 18 are often avoidable and commonly caused by accidental injuries or minor illnesses that could have been treated in primary care settings. From 2008 to 2012, there were over 320,000 road-related injuries and 2,300 road fatalities involving children and young people under the age of 25 in England. In the year 2014/15, there were 19.6 million recorded attendances at major A&E departments, single specialty A&E departments, walk-in centres and minor injury units in England. Approximately one-quarter (25.9%) of these attendances were made by children and young people aged 0-19 years.

This indicator covers A&E attendances for children as crude rates per 1,000 population aged under 18 years. We have included this indicator as the age range covers school-aged children.

A&E attendances for children as crude rates per 1,000 population aged under 18 years in Bury for 2023/24 was 438.3 per 1,000 population aged under 18 years and statistically better than the England average of 460.3 (Child and Maternal Health, 2024). Examining the trend in A&E attendances for children and young people under 18 years in Bury from 2021/22 to 2023/24, there has been a gradual decline in the rate of attendances. In 2021/22, the rate was 458.5 per 1,000, which decreased slightly to 448.2 per 1,000 in 2022/23 and further to 438.3 per 1,000 in 2023/24. In contrast, the trend for England over the same period has been more variable. The national rate increased from 439.8 per 1,000 in 2021/22 to 467.6 per 1,000 in 2022/23, before declining slightly to 460.0 per 1,000 in 2023/24 (Figure 8).

Figure 8: A&E attendance rate per 1,000 population aged 0-17 years from 2021/22 to 2023/24 (Child and Maternal Health, 2024)

Bury has the 7th highest rate of A&E attendance in its group of 16 statistical neighbours, with the highest rate in Stockton-on-Tees of 684.6 per 1,000 and lowest rate in Bracknell Forest at 288 per 1,000 for the year 2023/24 (Child and Maternal Health, 2024).

Data on inequalities for Bury are available by sex only, with higher rates in males (459.4 per 1,000 and statistically worse than Bury average) compared with females (415.9 per 1,000) for 2023/24 (Child and Maternal Health, 2024). England data are available by sex and levels of deprivation. Males under 18 years of age have a higher A&E attendance rate (459.4 per 1,000) compared with females (415.9 per 1,000) for 2022/23. Data by deprivation based on deprivation deciles suggests increasing emergency admission rates with increasing levels of deprivation. The most deprived decile in England has an attendance rate of 560.7 compared with 354.2 in the least deprived decile for the year 2023/24 (Child and Maternal Health, 2024).

Asthma

Asthma is the most common chronic medical condition in children in the UK (1.1 million) and it is characterised by varying levels of inflammation in the airways. Symptoms of airways inflammation include coughing, wheezing, shortness of breath and chest tightness. Standard asthma therapies, when used regularly and correctly, can control inflammation and symptoms in most children. Having well-controlled asthma reduces the likelihood of needing hospital care.

Acute asthma episodes are preventable. Often, asthma symptoms are accepted as normal, leaving airway inflammation untreated, increasing chances of those suffering from asthma having a life-threatening asthma attack. As a result, there are increased rates of acute care episodes and preventable deaths.

Understanding local trends in emergency admissions for asthma in children and young people with this long-term condition, as well as benchmarking against geographical and statistical neighbours, will aid in service review and redesign (Child and Maternal Health, 2024).

· Admissions for Asthma (0-9 years)

This indicator covers emergency admissions for asthma for children as crude rates per 100,000 population aged 0-9 years. We have included this indicator as the age range (0-9 years) covers school-aged children. The website link for this indicator is not included in the references below, as it was removed from the Fingertips platform at the time of updating the JSNA. We will update the references and include the link once the indicator becomes available again

Emergency admissions crude rate for asthma for children aged 0-9 years in Bury for 2022/23 was 193.1 per 100,000 population aged 0-9 years, statistically similar to the England average of 154.7 (Child and Maternal Health, 2023). This was the first time since 2010/11 that Bury has not been significantly worse than England in this measure. The crude rate per 100,000 of admissions for asthma in children aged 0-9 has reduced significantly in Bury, from 572.6 in 2010/11 to 193.1 in 2022/23. The rate has also declined in England, but at a slower rate, having reduced from 311.7 in 2020/11 to 154.7 in 2022/23 (Figure 9).

Figure 9: Admissions for Asthma (0 to 9 years) crude rate per 100,000 for Bury and England from the year 2010/11 to 2022/23 (Child and Maternal Health, 2023)

Bury has the fourth highest rate of admissions for asthma in its group of six statistical children service neighbours, with the highest rate in Lancashire of 245.4 and lowest rate in Sefton at 139 for the year 2022/23 (Child and Maternal Health, 2023).

Data on inequalities for Bury are available by sex only with higher rates in males (251.2 per 100,00) compared with females (132 per 100,000) for 2022/23 (Child and Maternal Health, 2023). England data are available by sex and levels of deprivation. Males aged 0-9 years have a higher asthma admission rate (189.3 per 100,000) compared with females (118.4 per 100,000). Data by deprivation based on deprivation deciles suggests increasing admission rates with increasing levels of deprivation. The most deprived decile in England has an admission rate of 234.7 per 100,000 compared with 89.9 per 100,000 in the least deprived decile for the year 2022/23 (Child and Maternal Health, 2023).

Diabetes

Insulin-dependent diabetes mellitus (IDDM), commonly known as type 1 diabetes, is a chronic (long-term) condition characterised by the inability of the pancreas to produce sufficient insulin. It primarily affects children and young individuals.

Effective management of insulin-dependent diabetes in children plays a crucial role in preventing emergency admissions. With proper education and support, children and their families can learn to recognise and respond to warning signs and symptoms of complications. Timely monitoring of blood glucose levels, adherence to insulin regimens and regular healthcare follow-ups are key to preventing acute episodes. Additionally, promoting healthy behaviour including a balanced diet and regular physical activity, can help maintain stable blood sugar levels and reduce the risk of emergencies. By implementing comprehensive diabetes care programmes, ensuring access to necessary medications and supplies and fostering awareness among healthcare providers, families and schools, the occurrence of emergency admissions related to insulin-dependent diabetes in children can be significantly reduced.

· Admissions for Diabetes (0-9 years)

This indicator covers emergency admissions for diabetes among children, presenting the crude rates per 100,000 population aged 0-9 years. The inclusion of this indicator is based on the age range's relevance to school-aged children. The website link for this indicator is also not included in the references below, as it was removed from the Fingertips platform at the time of updating the JSNA. We will update the references and include the link once the indicator becomes available again

For the year 2022/23, the crude rate of emergency admissions for diabetes among children aged 0-9 years in Bury was 42.9 per 100,000 population, which is statistically similar to the England average of 32.5 (Child and Maternal Health, 2023). There are limited available data for Bury, due to values being suppressed for disclosure control due to small count. However, where data are available, it shows that the rate for admissions for diabetes among children aged 0-9 years has fluctuated over the years in Bury, ranging from its lowest rate of 39 per 100,000 in 2010/11 to its peak in 2011/12 of 64 per 100,000. The rate in England has remained relatively stable, ranging from its lowest of 26.8 per 100,000 in 2018/19 to its highest of 37 per 100,000 in 2021/22 (Figure 10).

Figure 10: Admissions for diabetes (0 to 9 years) crude rate per 100,000 for Bury and England from the year 2010/11 to 2022/23 (Child and Maternal Health, 2023)

Bury ranks third in terms of admissions for diabetes among its group of six statistical children service neighbours, with Lancashire having the highest rate at 44.6 and Stockport having the lowest rate at 28.7 for 2022/23 (Child and Maternal Health, 2023).

Regarding inequalities, there are no available data specifically for Bury. However, England data indicates no significant disparities between sexes in terms of admission rates for diabetes, with 33.2 per 100,000 in males compared to 31.8 per 100,000 in females for 2022/23. There is no significant deprivation gradient by deprivation decile, although children in the least deprived deciles have the lowest emergency admission rate at 29.3 (Child and Maternal Health, 2023).

Epilepsy

Childhood epilepsy is a neurological condition characterised by recurring seizures. Seizures occur due to abnormal electrical activity in the brain, causing temporary disruptions in a child's normal functioning. These seizures can present in various ways, such as convulsions, loss of consciousness, confusion, or unusual sensations. The causes of epilepsy in children can be diverse, including genetic factors or brain injuries, although some cases have unknown origins. Collaborating closely with healthcare professionals is crucial for developing an individualised treatment plan, which may involve medications or other interventions to effectively manage and control seizures.

Emergency hospital admissions of children aged 0-9 years with a primary diagnosis of epilepsy provides valuable insights into the management and impact of epilepsy in this age group. These admissions reveal instances where children with epilepsy experienced seizures that required immediate medical attention and hospitalisation. Monitoring the frequency and causes of these emergency admissions can help identify potential gaps in epilepsy management, including medication adherence, seizure control and access to specialised care. It also highlights the need for effective education and support for families, caregivers and healthcare professionals in managing epilepsy and preventing seizures. By analysing these admissions, healthcare providers and policymakers can work towards improving epilepsy care, reducing the occurrence of status epilepticus and enhancing the overall well-being of children with epilepsy.

· Admissions for epilepsy (0-9 years)

This indicator covers emergency admissions for epilepsy among children, presenting the crude rates per 100,000 population aged 0-9 years. The inclusion of this indicator is based on the age range's relevance to school-aged children. The website link for this indicator is also not included in the references below, as it was removed from the Fingertips platform at the time of updating the JSNA. We will update the references and include the link once the indicator becomes available again

For the year 2022/23, the crude rate of emergency admissions for epilepsy among children aged 0-9 years in Bury was 42.9 per 100,000 population, which is statistically better than the England average of 92.9 (Child and Maternal Health, 2023). The rate in Bury has fluctuated significantly over the observed time period, ranging from its lowest rate which is the rate for 2022/23 of 42.9 per 100,000, to its peak of 141.3 per 100,000 in 2014/15. The rate in England has remained relatively stable, ranging from its highest rate in 2010/11 of 96.4 per 100,000 to its lowest rate of 82.1 in 2020/21 (Figure 11). Bury has remained not significantly different to the figure for England for all of the observed time period, with the exception of 2014/15 when Bury was significantly worse than England and 2022/23, when Bury was for the first time significantly better than England for admissions for epilepsy for 0 to 9 year olds.

Figure 11: Admissions for epilepsy (0 to 9 years) crude rate per 100,000 for Bury and England from the period 2010/11 to 2022/23 (Child and Maternal Health, 2023)

Bury has the lowest emergency admissions for epilepsy among its group of six statistical children service neighbours, with Stockton-on-Tees having the highest rate at 152.2 for 2022/23 (Child and Maternal Health, 2023).

Regarding inequalities, specific data for Bury are unavailable. However, data for England reveals higher admission rates for epilepsy among males (95.4 per 100,000) compared to females (90.4 per 100,000). A slight deprivation gradient is observed by deprivation decile, with children in the second least (76.4) and least deprived deciles (84.1) having the lowest emergency admission rates. Conversely, children in the second most deprived decile (107.5) have the highest emergency admission rate for 2022/23 (Child and Maternal Health, 2023).

Injuries

Injuries are a leading cause of hospitalisation and premature mortality in children and adolescents. They are also a source of long-term health problems, such as mental health issues related to the experience(s).

Examining hospital admissions caused by unintentional and deliberate injuries in children and young people is crucial for public health surveillance, injury prevention planning, resource allocation, policy development and evaluation of interventions. Understanding the causes of hospital admissions helps shape child safety policies, ensures appropriate allocation of healthcare resources and allows evaluation of preventive measures. This helps create safer environments for children and promotes their overall well-being.

Specific data regarding the ages that correspond to children in school are not available. Therefore, we will present data for two age groups: children aged 0-14 years and young people aged 15-24 years, which encompass the school-age range.

Hospital admissions caused by unintentional and deliberate injuries in children aged 0-14 years

The admissions data for children aged 0-14 are available as crude rate of hospital admissions caused by unintentional and deliberate injuries in children aged under 15 years per 10,000 resident population aged under 15 years.

Hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years) in the period 2023/24 for Bury are 60.6 per 10,000 resident population aged under 15 years, significantly better than the rate for England of 72.7 per 10,000. (Child and Maternal Health, 2024). The rate in Bury is decreasing and getting better (statistically significant) based on the 5 most recent data points , declining from 141.5 per 10,000 in 2010/11 when it was significantly worse than the England rate of 115.2, to its current rate of 60.6 which is its lowest rate and the first time Bury has been significantly better than England in this measure. The rate in England has also decreased over time, from 115.2 per 10,000 in 2010/11 to 72.7 in 2023/24 (Figure 12).

Figure 12: Hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years) crude rate per 10,000 for Bury and England from the period 2010/11 to 2023/24 (Child and Maternal Health, 2024)

Amongst Bury’s group of six statistical children service neighbours, Bury has the lowest hospital admissions in this age range, with the highest rate in Lancashire at 102.6 per 10,000 for 2023/24 (Child and Maternal Health, 2024).

Data on inequalities are present by sex only for Bury that suggest slightly higher hospital admissions rates in males of 69.4 per 10,000 resident population aged under 15 years (statistically similar to Bury average) compared with 51.2 per 10,000 in females (statistically similar to Bury average) (Child and Maternal Health, 2024).

This is consistent with the trend seen in England, where there is also a greater incidence of hospital admissions among males, with a rate of 78.2 per 10,000 residents under the age of 15, in comparison to females, who have a rate of 66.4 per 10,000 for 2023/24. Examining data by levels of deprivation, the highest hospital admissions rates are in the most deprived deciles (83.4) and the lowest in the least deprived decile (65.3 per 10,000 resident population aged under 15 years) (Child and Maternal Health, 2024).

Children killed and seriously injured (KSI)

Road traffic collisions are a major cause of deaths in children and comprise higher proportions of accidental deaths as children get older. Parents cite vehicle speed and volume as reasons why they do not allow their children to walk or cycle, thereby reducing opportunities for physical activity.

Children killed and seriously injured (KSI) is measured as crude rate of children aged 0-15 years who were killed or seriously injured in road traffic accidents per 100,000 population. Children KSI for Bury for the period 2020-2022 was 14.5 per 100,000 population, statistically similar to England average of 16.5 per 100,000 population (Child and Maternal Health Profile, 2022). No trend data are available for this measure.

Bury has the third lowest children killed and seriously injured rate in its group of six statistical children service neighbours for 2020-2022, with the highest in Lancashire at 34.3 per 100,000 population and the lowest in Stockport at 11.3 per 100,000 (Child and Maternal Health, 2022). There are no data on inequalities for Bury. Examining data by deprivation rate for children killed and seriously injured shows an increasing rate with increasing levels of deprivation. The 2nd most deprived decile in England has the highest rate (23.2) followed by the third most deprived decile (22.6) and then the most deprived decile (21.9), compared with the lowest rate of 10.3 in the least deprived decile for the period 2020-2022 (Child and Maternal Health, 2022). Data by sex for England shows a higher rate in males (21.1) compared with females (11.6).

Children aged 6-10 years killed or seriously injured in road traffic accidents

This indicator is measured as crude rate of children aged 6-10 years who were killed or seriously injured in road traffic accidents per 100,000 population.

Crude rate for children aged 6-10 years who were killed or seriously injured in road traffic accidents for the period 2020-2022 was 15.8 per 100,000 population,statistically similar to England average of 12.3 per 100,000 population (Child and Maternal Health Profile, 2022). No trend data are available for this measure.

Bury has the third highest rate for children aged 6-10 years who were killed or seriously injured in road traffic accidents in its group of six statistical children service neighbours for 2020-2022, with the highest in Lancashire at 23.1 per 100,000 population and lowest in Stockport at 5.5 per 100,000 population (Child and Maternal Health, 2022).

There are no data on inequalities for Bury, however examining data by deprivation rate for children aged 6-10 years killed and seriously injured suggests increasing rate with increasing levels of deprivation. The most deprived decile in England has the highest rate (18) followed by the second most deprived decile (17.6), compared with the lowest rate of 7.7 in the least deprived decile for the period 2020-2022 (Child and Maternal Health, 2022). Data by sex for England shows a higher rate in males (15 per 100,000 population) compared with females (9.4 per 100,000 population).

Children aged 11-15 years killed or seriously injured in road traffic accidents

This indicator is measured as crude rate of children aged 11-15 years who were killed or seriously injured in road traffic accidents per 100,000 population.

Crude rate for children aged 11-15 years who were killed or seriously injured in road traffic accidents for the period 2020-2022 was 26.1 per 100,000 population, statistically similar to the England average of 30.6 per 100,000 population (Child and Maternal Health Profile, 2023). No trend data are available for this measure.

Bury has the lowest rate for children aged 11-15 years who were killed or seriously injured in road traffic accidents in its group of six statistical children service neighbours, with the highest rate in Calderdale at 57.9 per 100,000 population (Child and Maternal Health, 2023).

There are no data on inequalities for Bury. Examining data by deprivation rate for England suggests increasing rate with increasing levels of deprivation. The second most deprived decile in England has the highest rate (44.2) followed by the third most deprived decile (43.8) and then the most deprived decile (38.8), compared with the lowest rate of 19.1 in the least deprived decile for the period 2020-2022 (Child and Maternal Health, 2023). Data by sex for England shows a higher rate in Males (40.6 per 100,000 population) compared with females (20 per 100,000 population) for 2020-2022.

Mental Health

Understanding and addressing mental health in children is crucial for their overall well-being. Various risk factors, including adverse childhood experiences, family dynamics, socioeconomic factors and access to mental health services, can impact children's mental well-being.

Hospital admissions as a result of self-harm (10-24 years)

Analysing data on hospital admissions for self-harm in children is of utmost importance in this regard. By closely examining such data, valuable insights are gained into the prevalence, patterns and severity of self-harm behaviours among children. Hospital admissions for self-harm in children have increased in recent years, with admissions for young women being much higher than admissions for young men. With links to other mental health conditions such as depression, the emotional causes of self-harm may require psychological assessment and treatment. This information helps identify high-risk groups, tailor interventions and provide timely support and prevention strategies. Accurate and comprehensive data on hospital admissions for self-harm in children is essential for shaping effective mental health policies, improving service provision and promoting the mental well-being of children.

Data for this indicator are presented as directly standardised rate of finished admission episodes for self-harm per 100,000 population aged 10-24 years. Hospital admissions rate as a result of self-harm for Bury during the period 2023/24 was 255.9 per 100,000 population aged 10-24 years, statistically similar to England average of 266.6 (Child and Maternal Health, 2024). Trend data based on the five most recent data points for Bury indicate a statistically significant decreasing trend. The rate in Bury rose from 400.6 per 100,000 in 2011/12, peaking at 557.5 per 100,000 in 2018/19, before steadily declining to its lowest recorded rate of 255.9 per 100,000 in 2023/24. A similar pattern is observed at the national level. In England, the rate increased from 347.4 per 100,000 in 2011/12 to a peak of 441.7 per 100,000 in 2018/19, followed by a decline to 266.6 per 100,000 in 2023/24 (Figure 13).

Figure 13: Hospital admissions as a result of self-harm (10 to 24 years) directly standardised rate per 100,000 for Bury and England from the year 2011/12 to 2023/24 (Child and Maternal Health, 2024)

In comparison to its six neighbouring statistical children services, Bury has the third highest rate of hospital admissions within this age range. The highest rate among Bury neighbours is observed in Sefton, with a rate of 316.1 per 100,000 population 10-24 years of age, while the lowest rate is in Calderdale, at 202.6 per 100,000 population for 2023/24 (Child and Maternal Health, 2024).

Data on inequalities in Bury are present by sex only. These indicate significantly higher rates of hospital admissions in females (statistically significant compared to Bury average), with a rate of 408.2 per 100,000. On the other hand, males in Bury have a rate of 118.6 per 100,000 for 2023/24 which is statistically lower than Bury average (Child and Maternal Health, 2024).

Data for England by sex suggests a similar pattern with higher (statistically significant) hospital admissions rates in females of 432.8 per 100,000 compared to males who have a rate of 104.3 per 100,000 (Child and Maternal Health, 2024).

Generally, higher rates of hospital admissions related to self-harm among females reflects complex emotional and societal realities. Females often find themselves navigating a path that can lead to feelings of intense pressure or distress, sometimes culminating in acts of self-harm. Influences such as societal expectations around appearance and traditional roles can intensify this journey. It is worth noting that females also tend to experience certain mental health challenges, like anxiety and depression, at a higher rate. These conditions are known to increase vulnerability to self-harming behaviours. However, these numbers solely represent hospital admissions and do not necessarily encompass the full spectrum of individuals who self-harm. In fact, males might not always reach out for or receive the help they need as readily.

Examining the data based on levels of deprivation, the lowest rates of admission are in the most deprived decile (215.4) and the highest rate of admissions are in the second least deprived (314), followed by the second most deprived (310.7) (Child and Maternal Health, 2024).

Hospital admissions as a result of self-harm (10-14 years)

This indicator is presented as a crude rate of finished admission episodes for self-harm per 100,000 population. Hospital admissions rate as a result of self-harm in 10-14 years for Bury for the period 2022/23 was 265.7 per 100,000 similar (statistically significant) to England average of 251.2 (Child and Maternal Health, 2023). The rate has fluctuated over time in Bury ranging from 176.6 in 2011/12, reaching its lowest rate of 134.8 in 2012/13, before then hitting its peak in 2013/14 at 364.3, which was the only time period where Bury was significantly worse than England in this measure. This is consistent with the variations seen in England, where the rate has increased from its lowest of 123.9 in 2011/12, reaching its peak of 307.1 in 2021/22 and then decreasing to 251.2 in 2022/23 (Figure 14).There is no significant trend in Bury based on the 5 most recent data points.

Figure 14: Hospital admissions as a result of self-harm (10 to 14 years) crude rate per 100,000 for Bury and England from the period 2011/12 to 2022/23 (Child and Maternal Health, 2023)

Bury has the fourth highest rate for admission episodes of self-harm in its group of six statistical children service neighbours with the highest rate in Sefton at 512.6 and lowest in Calderdale at 221.8 (Child and Maternal Health, 2023).

Data on inequalities for Bury are available by age, with lower rates in 10–14 year olds (265.7) and 20-24 year olds (208.7) and average rates (522.9) for 15-19 year olds for 2022/23 (Child and Maternal Health, 2023). Examining data on inequalities for England, a similar pattern is seen by age with lower rates in 10-14 year olds (251.2) and 20-24 year olds (244.4) and average rates (468.2) in 15-19 year olds (Figure 14).

Figure 15: Inequalities in crude rates of finished admission episodes for self-harm (10 to 24 years) per 100,000 population by age for 2022/23 in Bury and England

Examining data by deprivation for England shows varying rates of self-harm in the most deprived deciles compared with the least deprived decile. The highest rate is in the fifth more deprived decile (309.5) followed by the second least deprived (282.3) and fourth less (278.9) deprived decile and the lowest rate (189.6) is in the least deprived decile for 2022/23 (Child and Maternal Health, 2023).

Hospital admissions as a result of self-harm (15-19 years)

This measure is presented as the crude rate of completed admissions for incidents of self-harm per 100,000 individuals in the population. The rate of hospital admissions resulting from self-inflicted harm among individuals aged 15-19 years in Bury during the period 2022/23 stands at 522.9 per 100,000, which is statistically similar to the average rate of 468.2 in England (Child and Maternal Health, 2023). The rate in Bury has fluctuated over time, ranging from 472.7 in 2011/12, reaching its lowest at 450 in 2013/14, then reaching its peak at 943.5 in 2020/21, before reducing to its latest rate of 522.9 for 2022/23. Trend data based on the 5 most recent data points suggests a decreasing and getting better (statistically significant) trend. Although the rate in England has varied, not to the same extent as in Bury, having ranged from 472.1 in 2011/12, reaching its peak at 657.3 in 2018/19, then decreasing to its lowest rate of 468.2 in 2022/23 (Figure 16).

Figure 16: Hospital admissions as a result of self-harm (15-19 years) in Bury and England, Crude rate per 100,000 for the period from 2011/12 to 2022/23 (Child and Maternal Health Profiles, 2023)

Bury has the second highest rate of admission episodes for self-harm in its group of six statistical children service neighbours, with the highest rate in Stockton-on-Tees at 574.9 and lowest in Lancashire at 396.2 (Child and Maternal Health, 2023).

Data on inequalities for Bury are available by age and sex. Data on inequalities by age for Bury for hospital admissions as a result of self-harm can be seen in Figure 14 above. Data by sex suggests a higher rate (statistically significant) of self-harm in females aged 15-19 years (1384) in Bury compared with males (165.6) for 2021/22 (this is the most recent data available as data for males for 2022/23 was unavailable). Examining data on inequalities for England, a similar pattern is seen by sex with significantly higher rates in females (1085.7) compared with males (214.8) for 2021/22 (Child and Maternal Health, 2023).

Examining data by deprivation for England shows varying rates of self-harm by levels of deprivation overall. The highest rate is in the least deprived decile (737.3) and the lowest rate is in the second most deprived (547.1) and most deprived (558.6) deciles for 2022/23 (Child and Maternal Health, 2023).

Hospital admissions for mental health conditions (<18 years of age)

One in ten children aged 5-16 years has a clinically diagnosable mental health problem and, of adults with long-term mental health problems, half will have experienced their first symptoms before the age of 14. Self-harming and substance abuse are known to be much more common in children and young people with mental health disorders – with ten per cent of 15-16 year olds having self-harmed. Failure to treat mental health disorders in children can have a devastating impact on their future, resulting in reduced job and life expectations.

Hospital admissions for mental health conditions are presented as crude inpatient admission rate for mental health disorders per 100,000 population aged 0-17 years. The crude rate in Bury for 2023/24 was at 68.2, statistically similar to England’s average of 80.2 (Child and Maternal Health, 2024). Between 2010/11 and 2023/24, the rate of hospital admissions for mental health conditions among children and young people aged 0–17 in Bury has shown notable fluctuations. The rate began at 119.4 per 100,000 in 2010/11, then dropped significantly to 71.5 in 2011/12. A sharp increase followed, peaking at 140.1 per 100,000 in 2014/15, representing the highest rate during the period. This was followed by a marked decline to 57.7 per 100,000 in 2016/17, the lowest point in the trend. Since then, rates have varied, with some recovery and further dips, ending at 68.2 in 2023/24. In contrast, the England average remained relatively stable throughout the same period, with minor year-on-year fluctuations. National rates hovered around 90 admissions per 100,000, showing less volatility compared to Bury.

Figure 17 below shows how Bury has followed the England trend from 2018/19 to 2023/24.

Figure 17: Hospital admissions for mental health conditions per 100,000 population aged 0-17 years for the period from 2010/11 to 2023/24 (Child and Maternal Health, 2024).

Bury has the ranks 4th in its group of 6 children statistical neighbours with the highest rate in Sefton at 101.9 and lowest in Stockport at 54.6 (Child and Maternal Health, 2024)

Data on inequalities in Bury are available by sex only, with higher admission rates in Females (94.0 per 100,000 population aged 0-17 years) compared with Males (44.1 per 100,000 population aged 0-17 years) (Child and Maternal Health, 2024).

England data by sex shows higher admission rates (statistically significant) in Females at 106.8 compared with Males at 53.5 (Child and Maternal Health, 2024). Examining data by deprivation for England shows increasing rates of hospital admissions for mental health conditions (<18 years) by decreasing levels of deprivation overall. The highest rate is in the fourth less deprived decile (97.6) followed by the second least deprived decile (87.8) and the lowest rate (73.1) is in the third more deprived decile for 2023/24 (Child and Maternal Health, 2024).

Behavioural Risk factors:

To effectively nurture a healthier society, it is essential to address behavioural risk factors within our community. This section presents publicly available information on behavioural risk factors in school-aged children including obesity, physical activity and substance misuse.

Overweight and Obesity

Overweight and obesity in children, while being behavioural risks, are also a reflection of these wider determinants of health. These determinants shape not only the behavioural risk factors but also underscore the context in which these behaviours are nurtured. The socioeconomic status of a child's household can drive dietary choices, often resulting in reliance on affordable yet calorie-rich and nutrient-poor foodstuffs. This choice is reinforced by the wider food environment, such as the saturation of fast-food outlets. Education - both of the child and within the family - can define the understanding of balanced diets, importance of physical activity and the implications of excessive screen time. Moreover, the physical environment, or the extent of access to safe outdoor spaces for play and exercise, can substantially shape a child's physical activity levels. Simultaneously, societal norms and community infrastructures can propel or deter active living. Consequently, overweight and obesity in children, while being behavioural risks, are also a reflection of these wider determinants of health.

Living with excess weight during childhood appears to be linked to lower educational achievement and with a worse state of mental and emotional health, partly as a result of the stigma attached with obesity. The health consequences of childhood obesity include: increased blood lipids, glucose intolerance, Type 2 diabetes, hypertension, increases in liver enzymes associated with fatty liver, exacerbation of conditions such as asthma and psychological problems such as social isolation, low self-esteem, teasing and bullying.

Numerous studies have demonstrated that childhood obesity strongly predicts adult obesity, with obese children and adolescents having a five-fold increased risk of being overweight as adults compared to non-obese individuals. Average life expectancy is decreased by about three years as a result of obesity and severe obesity can reduce life expectancy as much as by lifelong smoking by up to ten years (Azhar, 2023)

Reception: Prevalence of overweight (including obesity)

This indicator is defined as proportion of children aged 4-5 years classified as overweight or living with obesity. For population monitoring purposes children are classified as overweight (including obesity) if their body mass index (BMI) is on or above the 85th centile of the British 1990 growth reference (UK90) according to age and sex. The population monitoring cut-off points for overweight and obesity are slightly lower than the clinical cut-off points used to assess individual children, this is to capture those children with an unhealthy BMI for their age and those at risk of moving to an unhealthy BMI.

Prevalence of overweight (including obesity) in Bury for the most recent year 2023/24 was 21.1%, statistically similar to England average of 22.1% (Child and Maternal Health, 2024).

Examining trend data for Bury from 2006/07 to 2023/24, prevalence of overweight (including obesity) gradually declined from 23% in 2006/07 to 18.5% in 2008/09. The subsequent years, however, experienced a gradual yet somewhat inconsistent upswing, punctuated by notable peaks at 24.1% in 2016/17 and 29.2% in 2020/21. There has been a decline each period from 29.2% in 2022/21 to 23.2% in 2021/22, 21.9% in 2022/23 and lately to 21.1% in 2023/24. A data gap exists for Bury in the 2019/20 period (Figure 18).

Data at the national level present a relatively consistent range of approximately 22.9% to 23.1% until 2020/21, when the data reflected a sharp rise to 27.7%. It decreased in 2021/22 to 22.3%, decreased again in 2022/23 to 21.3% but then rose slightly to 22.1% in 2023/24. Comparing Bury and England, Bury's rates were lower than England average from 2007/08 to 2015/16 (although statistically significant only for 2007 to 2010 and 2012 to 2014). However, Bury’s prevalence displayed a greater degree of fluctuation over time. Both Bury and England observed marked increases in 2020/21, with Bury showing a surge of 5.5% from the last recorded data in 2018/19 and England recording a 4.7% increase from the previous year. These escalations could be indicative of broader behavioural shifts, potentially prompted by the pandemic in 2020, which might have influenced diet patterns and physical activity levels among children (Child and Maternal Health, 2024).

Figure 18 Prevalence (%) of overweight (including obesity) in Reception for Bury and England from the period 2006/07 to 2023/24 (Child and Maternal Health, 2024)

Bury has the lowest prevalence (%) of overweight (including obesity) in its group of 6 statistical children service neighbours with the highest percentage in Sefton at 24.7% and 2nd lowest above Bury (21.1%) in Stockport at 21.4% (Child and Maternal Health, 2024). There are no data on inequalities at Bury level but England data suggests increasing prevalence of overweight (including obesity) with increasing levels of deprivation. The most deprived decile in England has a prevalence of 26.1% compared with 17.0% in the least deprived decile for the year 2023/24 (Child and Maternal Health, 2024). Data by ethnicity suggests highest prevalence of overweight (including obesity) in Black African (27.4%), followed by White Irish (26.7%) and White and Black Caribbean (26.6%). The lowest prevalence by ethnicity is in Chinese (10.3%), Indian (11.8%) and White and Asian (15.3%) (Child and Maternal Health, 2024). By Sex, males have a higher prevalence of 22.2% (statistically significant) compared with females (21.9%).

Reception: Prevalence of obesity (including severe obesity)

This indicator is defined as the proportion of children aged 4-5 years classified as living with obesity. For population monitoring purposes children are classified as living with obesity if their body mass index (BMI) is on or above the 95th centile of the British 1990 growth reference (UK90) according to age and sex.

Prevalence of obesity (including severe obesity) in Reception for Bury in 2023/24 was 8.8%, statistically similar to England average of 9.6% (Child and Maternal Health, 2024)

Trend data for Bury and England are available from 2006/07 to 2023/24. Obesity (including severe obesity) prevalence in Reception aged children in Bury ranged from 7.7% to 15.6%. Prevalence of obesity declined from 10% in 2006/07 to 7.7% in 2014/15. This was followed by an increase to 10.6% in 2016/17 with fluctuations until reaching a peak in 2020/21 to 15.6%, before declining in the following 3 periods to 8.8% in 2023/24. Obesity in England was fairly stable with slight fluctuations from 2006/07 to 2019/20. In 2020/21, the prevalence increased by 4.5% to 14.4%, before declining to 10.1% in 2021/22 and to 9.2% in 2022/23. It increased slightly in 2023/24 to 9.6%.

Both Bury and England observed marked increases in 2020/21, with Bury showing a surge of 5% from the last recorded data in 2018/19 and England recording a 4.5% increase from the previous year (Figure 19) (Child and Maternal Health, 2024)

Figure 19: Prevalence (%) of obesity (including severe obesity) in Reception for Bury and England from the period 2006/07 to 2023/24 (Child and Maternal Health, 2024)

Bury has the lowest prevalence of obesity (including severe obesity) in Reception in its group of 6 statistical children service neighbours with the highest prevalence in Sefton at 10.9% and 2nd lowest above Bury (8.8%) in Stockport at 9.0% (Child and Maternal Health, 2024).

There are no data on inequalities for Bury. Data on inequalities are available at England level by sex, ethnicity and deprivation. The data on obesity prevalence, inclusive of severe obesity cases, within England shows higher prevalence in males at 9.9% (statistically significant), as compared to females at 9.4%. Furthermore, when the data are stratified by ethnicity, the highest prevalence rates are among those from Black African (14.2%), any other black background (13.2%) and White and Black Caribbean (12.9%) ethnic groups. Conversely, the ethnic groups with the lowest prevalence rates include Chinese (4.4%), Indian (6.2%) and White and Asian background (6.3%), Data by deprivation shows a clear deprivation gradient with higher prevalence of obesity in the most deprived decile at 12.9% and lowest in the least deprived decile at 6.0%.

Year 6: Prevalence of overweight (including obesity)

This indicator measures the proportion of children aged 10-11 years classified as overweight or living with obesity. For population monitoring purposes children are classified as overweight (including obesity) if their body mass index (BMI) is on or above the 85th centile of the British 1990 growth reference (UK90) according to age and sex. The population monitoring cut-off points for overweight and obesity are slightly lower than the clinical cut-off points used to assess individual children, this is to capture those children with an unhealthy BMI for their age and those at risk of moving to an unhealthy BMI. Prevalence of overweight (including obesity) in Bury for the year 2023/24 was 35.5%, statistically similar to England average of 35.8% (Child and Maternal Health, 2024).

Examining trend data for Bury from 2006/07 to 2023/24, prevalence of overweight (including obesity) gradually increased from 29.5% in 2006/07 to 34.3% in 2018/19. There is a data gap for 2019/20 but data for 2021/21 shows the highest rate for over a decade at 41.2%. The most recent figure indicates a decline to 35.5% in 2023/24. (Child and Maternal Health, 2024).

Data at the national level follows a similar trend with increasing prevalence from 31.7% in 2006/07 to 35.3% in 2019/20. This was followed by a sharp rise to 40.9% in 2020/21. From 2021/21 prevalence of obesity (including overweight) decreased to 37.8% in 2021/22, to 36.6% in 2022/23 and it has fallen again in 2023/24 to 35.8%. Comparing Bury and England, Bury's rates were fairly similar to England average from 2007/08 to 2021/22, with the exception of 2011/12, where rates in Bury were lower (31.6%) than England average (33.9%) and again in 2022/23 when the rates for Bury (39.4%) were significantly worse than those for England (36.6%) (Figure 20) (Child and Maternal Health, 2024).

Figure 20: Prevalence (%) of overweight (including obesity) in Year 6 for Bury and England from the period 2006/07 to 2023/24  (Child and Maternal Health, 2024)

Bury has the 2nd lowest prevalence (%) of overweight (including obesity) (35.5%) in its group of 6 statistical children service neighbours with the highest percentage in Stockton-on-Tees at 38.6% and lowest in Stockport at 33.6% (Child and Maternal Health, 2024). There are no data on inequalities at Bury level but England data suggests increasing prevalence of overweight (including obesity) with increasing levels of deprivation. The most deprived decile in England has a prevalence of 43.3% compared with 25.2% in the least deprived decile for the year 2023/24 (Child and Maternal Health, 2024). Data by ethnicity suggests highest prevalence of overweight (including obesity) in Black African (46.0%), followed by Any other Black background (45.7%) and Black Caribbean (45.6%). The lowest prevalence by ethnicity is in Chinese (24.5%), White and Asian (34.2%) and White British (30.5%) (Child and Maternal Health, 2024). By Sex, males have a higher prevalence at 38.1% (statistically significant) compared with females (33.5%).

Year 6: Prevalence of obesity (including severe obesity)

This indicator measures proportion of children aged 10-11 years classified as living with obesity or severe obesity. For population monitoring purposes children are classified as living with obesity if their body mass index (BMI) is on or above the 95th centile of the British 1990 growth reference (UK90) according to age and sex.

Prevalence of obesity (including severe obesity) in Year 6 for Bury was 22.3%, statistically similar to England average of 22.1% (Child and Maternal Health, 2024)

Trend data for Bury and England are available from 2006/07 to 2023/24. Obesity (including severe obesity) prevalence in Year 6 children in Bury ranged from 15.1% to 25.8%. In 2006/07, prevalence was the lowest at 15.1% lower (statistically significant) than England average of 17.5% during the same period. Prevalence increased gradually until 2013/14, where it was 20.5%. This was followed by a decline to 17.2% in 2013/14, statistically significant and lower than England average of 19.1% during this period. This was followed by another period of gradual increase to 25.8% in 2020/21. No data are available for Bury in 2019/20 (due to COVID-19). The most recent data for 2023/24 suggests a decline from a high of 25.8% in 2020/21 to 22.3%.

Prevalence of obesity in England increased gradually from 17.5% in 2006/07 to 21% in 2019/20. This was followed by a sharp rise to 25.5% in 2020/21, before declining over subsequent periods to 22.1% in 2022/23 (Figure 21).

Figure 21: Prevalence (%) of obesity (including severe obesity) in Year 6 for Bury and England from the period 2006/07 to 2023/24 (Child and Maternal Health, 2024)

Both Bury and England observed marked increases in 2020/21, with Bury showing a surge of 4.6% from the last recorded data in 2018/19 and England recording a 4.5% increase from the previous year (Child and Maternal Health, 2024).

Bury has the 4th highest prevalence of obesity (including severe obesity) in Year 6 in its group of 6 statistical children service neighbours with the highest prevalence in Stockton-on-Tees at 24.6% and lowest in Stockport at 19.7% (Child and Maternal Health, 2024).

Percentage of physically active children and young people

The UK Chief Medical Officers' (CMOs') recommend that children and young people (5 to 18 years) are physically active for an average of at least 60 minutes per day across the week. The evidence suggests, however, that a significant proportion of adolescents do not meet this minimum standard.

Regular moderate to vigorous physical activity (MVPA) improves health and fitness, strengthens muscles and bones, develops coordination, maintains healthy weight, improves sleep, makes you feel good, builds confidence and social skills and improves concentration and learning.

Good physical activity habits established in childhood and adolescence are also likely to be carried through into adulthood. If we can help children and young people to establish and maintain high volumes of physical activity into adulthood, we will reduce the risk of morbidity and mortality from chronic non communicable diseases later in their lives.

The percentage of children (5 to 15) undertaking an average of at least 60 minutes of physical activity per day across the week is a Key Performance Indicator for the Government’s sports strategy ‘Sporting Future: A new strategy for an active nation’.

The Active Lives Children and Young People (CYP) Survey is the only national data source for physical activity levels that is available at local authority level and the data will shape and influence local decision making as well as inform government policy on the Primary PE and Sports Premium, Childhood Obesity Plan and other cross departmental programmes.

Physical activity also forms a key component of the government’s plan for action to significantly reduce childhood obesity by supporting healthier choices, as outlined in ‘Childhood obesity: a plan for action’. One of the main aspects of the plan is to reduce childhood obesity by encouraging primary school children to eat more healthily and stay active.

Physically activity in CYP is measured as percentage of children aged 5 to 16 that meet the UK Chief Medical Officers' (CMOs') recommendations for physical activity (an average of at least 60 minutes moderate to vigorous intensity activity per day across the week).

For the year 2023/24, 49.2% of CYP in Bury were physically active, statistically similar compared with 47.8% in England for the same time period (Child and Maternal Health, 2025).

Looking at the trend over time in Bury, the proportion of physically active CYP declined from 42.5% in 2017/18 to a low of 38.1% in 2020/21. This was followed by a notable recovery, with activity levels rising by 9 percentage points to 47.1% in 2021/22 and continuing to increase to 49.2% in 2023/24.

Nationally, England experienced some fluctuations in physical activity levels among CYP. The proportion rose from 43.3% in 2017/18 to 46.8% in 2018/19, then dipped to 44.6% in 2020/21. It rebounded to 47.2% in 2021/22, slightly decreased to 47.0% in 2022/23 and rose again to 47.8% in 2023/24.

Figure 21: Proportion of physically active Children and Young People (CYP) for Bury and England for the period 2017/18 to 2023/24 (Child and Maternal Health, 2025)

Bury ranks 2nd in its group of 6 children services statistical neighbours with the highest proportion of physically active CYP in Stockton-on-Tees at 51.9% and lowest in Stockport at 42.4% (Child and Maternal Health, 2025).

There are no data on inequalities for Bury. Data by Sex for England suggests that there are higher (51.2%) proportion of males that are physically active compared with females (44.8%). The highest levels of physical activity in CYP in England by ethnicity are in White other and White British (both at 49.9%) and the lowest are in Black (42.3%) and Asian (43.1%). Comparing by school year group in England, the highest levels of physical activity is at 53% of Year 1 and 2 children, followed by 49% in Year 7 to Year 11. The lowest proportion is in Year 3 to Year 6 at 43.8%.

Admission episodes for alcohol-specific conditions - Under 18s

The role of alcohol consumption in hospital admissions and mortality from various health conditions is noteworthy. Estimated annual expenditures stand around £3.5 billion for the NHS and £21 billion for society due to alcohol misuse. The government states that collective efforts are required to mitigate the excessive use of alcohol. In this context, this indicator serves as a pivotal strategy by the government and the Department of Health, to facilitate tangible, data-driven prevention activities at the local level. It aligns with the national goals outlined in the Government's Alcohol Strategy to decrease harm and is monitored through the Responsibility Deal Alcohol Network. Alcohol-related admissions can be reduced via local strategies aimed at lessening alcohol misuse and related harm.

Public Health England has identified reducing alcohol-related harm as one of its top seven priorities for the upcoming five years, as per the 2014 "Evidence into action" report. The 2013 Sexual Health Framework brings to light several points:

• A correlation exists between alcohol-related hospital admissions in both sexes and teenage pregnancy, even after adjusting for the prevalent and significant effect of deprivation and similar is observed for common sexually transmitted infections.
• There is substantiated evidence indicating that alcohol consumption and intoxication can lead to reduced inhibitions and imprudent judgements regarding sexual behaviour, vulnerability and risky sexual practices, including lack of contraception or condom usage.
• Alcohol intake among younger individuals is linked with a higher likelihood of early sexual activity. Alcohol misuse correlates with a higher number of sexual partners and an increase in regrettable or coerced sexual experiences.
• Furthermore, alcohol increases the risk of sexual aggression, sexual violence and sexual victimisation, particularly in women.

The indicator presents crude rate per 100,000 population under 18 years of age where the primary diagnosis or any of the secondary diagnoses are an alcohol-specific (wholly attributable) condition. (OHID, 2025).

For the year period 2021/22-2023/24, the crude rate of admission episodes for alcohol-specific conditions for CYP under 18 years of age in Bury was 9.9 per 100,000 population aged under 18 years, statistically better than England average of 22.6 per 100,000 (Child and Maternal Health, 2025).

Examining trend for Bury, alcohol-specific admission rate steadily declined from the highest rate of 43.1 in 2012/13-2014/15 to 26.7 in 2016/17-2018/19. This was followed by an increase in 2017/18-2019/20 to 34.2 before declining every period to 9.9 in the latest period 2021/22-23/24. The decline in Bury signals a reduction in alcohol-specific admissions in the area suggesting possible successful interventions or changes in drinking behaviours amongst this age group. England saw a consistent gradual decline, although at a less pronounced rate as Bury, from 39.2 in 2012/13-14/15 to 22.6 in 2021/22-23/24 (Child and Maternal Health, 2025) (Figure 22).

Figure 22: Crude rates of admission episodes for alcohol-specific conditions rate per 100,000 population under 18 years of age for Bury and England from the period 2012/13-14/15 to 2021/22-23/24 (Child and Maternal Health, 2025)

For 2021/22-23/24 Bury has the lowest crude rates of admission episodes for alcohol-specific conditions rate per 100,000 population under 18 years of age in its group of 6 statistical children service neighbours with the highest rate in Stockton-on-Tees at 29.8 and Lancashire the 2nd lowest at 23.5 (Child and Maternal Health, 2025).

Data on inequalities for Bury are available by sex only, with higher rates of admissions in females (11.0) compared with males (8.8). However, the rates in males and females are statistically similar to Bury average. Data by sex for England suggests that there are higher rates (30.0) of alcohol admissions in females compared with males (15.4). The rates in males are statistically lower and the rates in females are statistically higher than England average. Examining data by deprivation decile for alcohol-specific conditions admission rates in children under 18 years of age, the 5th more (26.2) and 3rd less deprived decile (25.7) in England has the highest rate and lowest rate of 19.1 is in the least deprived decile for the period 2021/22-2023/24 (Child and Maternal Health, 2025).

Education

Education brings many benefits, for the individual and for society as a whole. It improves career prospects, boosts the economy and even extends our lifespans. Education is not only about acquiring knowledge and skills but also about personal growth, critical thinking and social development. Learning ensures that children develop the knowledge and understanding, skills, capabilities and attributes that they need for mental, emotional, social and physical wellbeing now and in the future.

Children with poorer mental health are more likely to have lower educational attainment and there is some evidence to suggest that the highest level of educational qualifications is a significant predictor of wellbeing in adult life; educational qualifications are a determinant of an individual's labour market position, which in turn influences income, housing and other material resources.

Educational attainment is influenced by both the quality of education children receive and their family socio-economic circumstances. Monitoring the achievements and outcomes of education is important for assessing how effective educational systems are and identifying areas that need improvement. Indicators such as educational attainment, resilience and emotional well-being offer valuable insights into the experiences and outcomes of young people in education. These indicators guide policies and interventions to ensure equitable access to excellent education for all.

School readiness

Children are defined as having a good level of development at the end of the early years foundation stage (EYFS) if they are at the expected level for the 12 early learning goals (ELGs) within the 5 areas of learning relating to:

• communication and language
• personal, social and emotional development
• physical development
• literacy
• mathematics.

EYFS reforms were introduced in September 2021, as part of those reforms, the EYFS profile was significantly revised. It is therefore not possible to directly compare 2021 to 2022 assessment outcomes with earlier years. The 2019 to 2020 and 2020 to 2021 data collections were cancelled due to coronavirus (COVID19).

Percentage of children achieving a good level of development at the end of Reception

In 2023/24, 65.0% of children in Bury achieved a good level of development at the end of Reception, which is statistically worse than the national average of 67.7%. This represents a slight decrease from 2022/23, when 65.7% of children in Bury met this benchmark, a figure that was statistically similar to England’s 67.2%. In 2021/22, 63.3% of children in Bury achieved a good level of development, also statistically similar to the national average of 65.2%.Child and Maternal Health 2025. The recent trend could not be calculated (Figure 23).

Figure 23: Percentage (%) of children achieving a good level of development at the end of Reception for Bury and England for the period 2021/22 to 2023/24(Child and Maternal Health, 2025)

Bury has the 4th highest percentage of children achieving a good level of development at the end of Reception in its group of 6 statistical children service neighbours with the highest percentage in Stockton-on-Tees at 69.5% and lowest in Sefton at 62.7% (Child and Maternal Health, 2025).

Data on inequalities for Bury are available by sex. For 2023/24, 73.5% of females achieved a good level of development at the end of Reception, statistically better than the Bury average, compared to 58% of males, statistically worse than the Bury average.

Data on inequalities for England are available by deprivation, ethnic groups, first language status, special educational needs (SEN) status, month born and by sex.

Analysis of the data on deprivation shows a higher percentage of school readiness in the least deprived deciles and a lower percentage of school readiness in the most deprived deciles. In 2023/24, 71.7% of children in the least deprived decile achieved a good level of development at the end of Reception, 69.7% in the 3rd less deprived decile and 69.6% in the 2nd least deprived decile. In the most deprived decile, 62.8% of children achieved a good level of development at the end of Reception, 65.6% in the 2nd most deprived decile and 66.3% in the 3rd more deprived decile.

Inequalities for ethnic groups show the mixed/multiple (69.5%) and white (69.2%) ethnic groups having the highest and statistically better proportion of children achieving a good level of development at the end of Reception in 2023/24. Not known/not stated (50.4%) and other ethnic groups (60.2%) have the lowest and statistically worse proportions than the England average.

Inequalities by first language status show those whose first language is English have the highest and statistically better proportion of children achieving a good level of development at the end of Reception in 2023/24, at 69.7%. Those whose first language is other than English (63.5% and unclassified (48.6%) are both statistically worse than the England average.

Special educational needs (SEN) status inequality data shows 24.9% of children with SEN support and 3.8% of children with a Statement or EHCP have the lowest rates of achieving a good level of development at the end of Reception. Data shows 75.6% of children in England with no identified SEN achieved a good level of development at the end of Reception in 2023/24.

A higher percentage of children achieving a good level of development at the end of Reception was seen in those born in the autumn (75.6%) compared to those born in the spring (69.5%) with children born in the summer having the lowest proportion achieving a good level (60.0%).

By sex, a higher percentage of females (75.0%) achieved a good level of development at the end of Reception compared to males (60.7%).

Percentage of children with free school meal status achieving a good level of development at the end of Reception

In 2023/24, 48.7% of children with free school meal status in Bury achieved a good level of development at the end of Reception. This was lower than the national average of 51.5%, but the difference was not statistically significant. In 2022/23, the proportion in Bury had slightly decreased to 48.4%, also statistically similar but lower than England’s 51.6%. In 2021/22, 50.2% of children with free school meal status in Bury reached a good level of development, which was higher but still statistically similar to the national figure of 49.1%. A recent trend could not be calculated (Figure 24). (Child and Maternal Health 2025)

Figure 24: Percentage (%) of children with free school status achieving a good level of development at the end of Reception for Bury and England for the period 2021/22 to 2023/24 (Child and Maternal Health, 2025)

Bury has the 2nd highest percentage of children with free school meal status achieving a good level of development at the end of Reception in its group of 6 statistical children service neighbours with the highest percentage in Stockton-on-Tees at 54.1% and lowest in Sefton at 41.3% (Child and Maternal Health, 2025).

Data on inequalities for Bury are available by sex. For 2023/24, 58.6% of females achieved a good level of development at the end of Reception, statistically better than the Bury average, compared to 41.2% of males, statistically similar to the Bury average.

Data on inequalities for England are available by deprivation, ethnic groups, special educational needs (SEN) status and by sex.

Analysis of the data on deprivation shows a higher percentage of children with free school meal status achieving a good level ot development at the end of Reception in the most deprived deciles and a lower percentage in the least deprived deciles. In 2023/24, 54.2% of children with free school meal status in the most and 2nd most deprived deciles achieved a good level of development at the end of Reception. In the least deprived decile, 46.6% of children achieved a good level of development at the end of Reception, 48.2% in the 2nd least deprived decile and 48.6%% in the 4th least deprived decile.

Inequalities for ethnic groups show the Asian/Asian British including Chinese (59.4%) and Black/African/Caribbean/Black British (57.3%) ethnic groups having the highest and statistically better proportion of children with free school meal status achieving a good level of development at the end of Reception in 2023/24. White (49.1%) had the lowest and statistically worse proportions when compared to England average with not known/not stated (50.8%) having a statistically similar proportion to England average.

Special educational needs (SEN) status inequality data shows 19.3% of children with SEN support and 3.1% of children with a Statement or EHCP with free school meal status have the lowest rates of achieving a good level of development at the end of Reception. Data shows 61.2% of free school meal status children in England with no identified SEN achieved a good level of development at the end of Reception in 2023/24.

By sex, a higher percentage of females (60.1%) with free school meal status achieved a good level of development at the end of Reception compared to males (43.2%).

School readiness comparison of data for children with and without free school meal status.

In Bury, for the period 2023/24, 65.0% of children without free school meal status achieve a good level of development at the end of Reception compared to 48.7% of children with free school meal status (figure 25).

Figure 25: Inequalities in percentage (%) of children achieving a good level of development at the end of Reception in Bury for the period 2023/24 (Child and Maternal Health, 2025)

Key Stage 4

Key Stage 4 is the final stage of secondary education in England, typically covering Years 10 and 11, when pupils are aged 14 to 16. It is a crucial phase as it culminates in the completion of compulsory education and leads to various pathways for further education, training, or employment.

Average Attainment 8 score

Academic achievement of pupils at the end of Key Stage 4 is measured as the Average Attainment 8 score. The Attainment 8 score is calculated by assigning point values to a pupil's performance in a set of specified subjects, including English (both literature and language), mathematics, sciences, humanities and additional optional subjects. Each subject is assigned a point value based on the pupil's attainment level, with higher scores awarded for higher grades. The points achieved across all subjects are then added up to calculate the Attainment 8 score.

This indicator is presented as a mean score for all pupils in state-funded schools, based on local authority of pupil residence.

Most recent data from 2022/23 suggests that the Average Attainment 8 score in Bury was 45.6 similar to NW average (44.5) and slightly lower than England average of 46.2 (Child and Maternal Health, 2024).

Please note that Trend chart is not displayed as the way GCSE grades were awarded changed during the Covid-19 pandemic. 2020 and 2021 data should not be directly compared to attainment data from previous years for the purposes of measuring changes in pupil performance.

Bury has the 4th lowest Average Attainment 8 score in its group of 6 statistical children service neighbours with the highest score in Stockport at 47.6 and lowest in Sefton at 42.8 (Child and Maternal Health, 2024).

No data on inequalities are available for Bury. For England, inequalities data are available for deprivation, ethnic groups, first language status, special educational needs (SEN) status, eligibility for free school meals and sex.

Deprivation data for England shows the highest mean score (52.2) is obtained in the least deprived decile. The score for the most deprived decile is 43.3.

The ethnic group with the highest score in England is Asian/Asian British including Chinese, followed by other ethnic group at 46.9.The lowest score of 42.0 is in the not known/not stated group, followed by White ethnic group at 45.1.

Those with a first language other than English in England have the highest score of 48.5 compared to 45.8 for those with English as a first language.

For SEN status in England, those with SEN support have a score of 33.2, those with a Statement or EHCP have a score of 14.0, with those having no identified SEN the score is 49.9.

Children in England eligible for free school meals scored 34.7, compared to a score of 49.5 for those children not eligible for free school meals.

For sex, females scored higher at 48.5 than males at 43.9.

Average Attainment 8 Score among children eligible for Free School Meals (FSM)

Educational attainment is influenced by both the quality of education children receive and their family socio-economic circumstances. Being on FSM is considered to be a good indicator of socio-economic disadvantage in the UK. Children and young people in the UK are usually eligible for free school meals (FSM) if their parents or carers are on a low income or in receipt of certain benefits. Children on FSM perform relatively poorly compared to counterparts without FSM.

This indicator shows attainment for children eligible for free school meals. Attainment is measured via the Average Attainment 8 measure which is calculated by adding together a pupil’s highest scores across eight government approved qualifications (including GCSEs and EBacc). Pupils are at the end of Key Stage 4 (KS4) aged 15-16 and attending state-funded schools in England.

Most recent data from 2020/21 suggests that the Average Attainment 8 score of children on FSM in Bury is in the 2nd worst quintile in England at 37.9, with the England average at 39.1 (Child and Maternal Health, 2022).

No trend data are available for Bury and England.

No inequalities data are present for Bury and England. However, this indicator should be compared to the general Average Attainment 8 Score. As pupils eligible for FSM fall under the definition of disadvantage, it can be useful to see the difference in average scores and whether local and national policy interventions are having an impact. This indicator is ily available for 2020/21 for Bury and presented below (Figure 26).

Figure 26: Inequalities in Average 8 Attainment scores comparing Average 8 Attainment score with Average 8 Attainment score among children eligible for FSM in Bury for the period 2020/21

Average Attainment 8 score - Children in care

This indicator presents Key Stage 4 average Attainment 8 score of children looked after continuously for at least twelve months at the end of March (excluding children in respite care). Only children who have been matched to Key Stage 4 data are included. This is the amended version of Key Stage 4 data. Includes entries and achievements for these pupils in previous academic years.

Most recent data from 2022/23 shows the Average Attainment 8 score of children in care in Bury at 19.0, with the England average at 19.4 (Child and Maternal Health, 2024).

Please note that Trend chart is not displayed as the way GCSE grades were awarded changed during the Covid-19 pandemic. 2020 and 2021 data should not be directly compared to attainment data from previous years for the purposes of measuring changes in pupil performance.

Bury has the 3rd highest Average Attainment 8 score in its group of 6 statistical children service neighbours with the highest score in Stockton-on-Tees at 21.2 and lowest in Stockport at 14.9 (Child and Maternal Health, 2024).

No data on inequalities are available for Bury. For England, inequality data are available for deprivation, ethnic groups and Special Educational Needs (SEN) status.

Data for deprivation in England shows those in the most deprived and 5th more deprived deciles had the highest score of 20.8. The lowest score of 17.6 was in the 5th less deprived decile.

The mixed/multiple ethnic group in England had the highest score of 24.6, followed by white ethnic group at 23.4. The lowest score was in the other ethnic group at 13.2.

For SEN status, those with SEN support have a score of 22.4 in England and those with a statement or EHCP have a score of 7.3. Those with no identified SEN had a score of 31.2.

Educational Inclusion and Engagement:

Promoting educational inclusion and engagement is crucial for ensuring every child and young person has equal opportunities to thrive academically and socially. It involves creating an inclusive educational environment that supports the needs of all pupils, including those facing challenges or barriers to learning. By addressing factors like disengagement, absence and exclusion, we can strive for educational equity and positive outcomes for every pupil. This set of indicators provides valuable insights into different aspects of educational inclusion and engagement, such as the rate of 16 to 17 year olds not in education, employment or training (NEET) or whose activity is unknown, the rates of persistent absentees and fixed-term exclusions in both primary and secondary schools, pupil absence rates and the percentage of pupils with special educational needs (SEN). These indicators help identify areas where support and interventions may be needed, guiding efforts to ensure all pupils have access to quality education and the opportunity to reach their full potential.

Pupil absence

Parents of children of compulsory school age (aged 5 to 15 at the start of the school year) have a legal responsibility to ensure that their children receive a suitable education through regular attendance at school or other approved educational arrangements. The educational attainment of children is influenced by multiple factors, including the quality of education they receive and their family's socio-economic circumstances. Educational qualifications play a significant role in determining an individual's position in the labour market, which, in turn, impacts their income, housing situation and access to material resources. These factors are interconnected with health outcomes and disparities.

Promoting improved attendance in schools is a crucial aspect of the government's commitment to enhancing social mobility and ensuring that every child can fulfil their potential. Improving school attendance requires a collaborative effort among various services that engage with young people to establish local priorities and strategies. The indicator related to school attendance can serve as a valuable tool in achieving this objective and fostering positive educational outcomes for children and young individuals.

Percentage of pupil absence

This indicator is measured as a percentage of half days missed by pupils due to overall absence (including authorised and unauthorised absence).

Most recent data on pupil absence in Bury are available for year 2022/23, where pupil absence is at 7.1%, statistically similar to England average of 7.4%.

The percentage of pupil absence has shown some variations over the years. Prior to 2021/22, pupil absence ranged from the highest at 5.2% in 2010/11 to the lowest of 3.9% in 2013/14 however it spiked to 7.1% in 2021/22 and remained at that for 2022/23. The percentage of pupil absence in England followed a similar pattern. It was slightly higher than Bury in 2010/11 at 5.8% but decreased to a low of 4.5% in 2013/14. The percentage remained relatively stable in other years. Similarly to Bury, England spiked in 2021/22 to 7.6%, dropping slightly to 7.4% in 2022/23.

Pupil absence in Bury remained lower than England average (statistically significant) from 2010/11 to 2015/16 and similar to England average from 2016/17 to 2020/21. In 2021/22 Bury was statistically lower than England and statistically similar to England in 2022/23.

Trend data based on the 5 most recent data points show trend to be increasing and getting worse (Figure 27).

Figure 27: Percentage (%) of pupil absence for Bury and England from the period 2010/11 to 2022/23 (Child and Maternal Health, 2024)

Bury has the 4th highest proportion of pupil absence in its group of 6 statistical children service neighbours with the highest percentage in Sefton at 7.9% and lowest in Stockport at 6.9% (Child and Maternal Health, 2024).

There are no data on inequalities in Bury.

Data for England are available by ethnic groups, deprivation and sex.

Analysis of data for England by ethnic groups reveals Chinese (3.4%) and Black (5.4%) ethnic groups have the lowest proportion (statistically significant when compared to England average) of pupil absence and the highest proportion (statistically significant compared to England average) are in Unknown (9%) and Mixed (7.8%) ethnic groups.

Inequalities are also observed by levels of deprivation with the increasing pupil absence with increasing levels of deprivation. The highest pupil absence is in the most deprived decile (7.9%) and lowest in the least deprived decile (6.6%).

Data by sex suggests that pupil absence is slightly higher in females (7.4%) compared with males (7.3%).

Persistent absentees - Primary school

This indicator is defined as the percentage of primary school enrolments classed as persistent absentees (defined as missing 10% or more of possible sessions).

Persistent absentees in primary school in Bury based on the most recent data from 2022/23 was at 14.5%, lower (statistically significant) than England average of 16.2%.

The percentage of persistent absentees in primary schools in Bury fluctuated over the years, with the highest percentage of 9.0% in 2016/17 and the lowest percentage of 7.0% in 2014/15. The percentage of persistent absentees was 7.0% in 2014/15 and increased slightly to 7.1% in 2015/16. However, there was a notable increase to 9.0% in 2016/17, indicating a significant rise in persistent absenteeism. The percentage then decreased to 8.8% in 2017/18, followed by a further decrease to 7.7% in 2018/19. In 2020/21, the percentage increased slightly to 8.1%.

Similarly, the percentage of persistent absentees in primary schools in England fluctuated over the years, with the highest percentage of 8.8% in 2020/21 and the lowest percentage of 8.2% in 2015/16. In England, the percentage of persistent absentees was 8.4% in 2014/15 and decreased to 8.2% in 2015/16. It remained relatively stable between 8.3% and 8.8% in the subsequent years. The percentage increased to 8.8% in 2020/21.

Bury generally had a lower percentage of persistent absentees compared to the national average for England and the range of values in Bury was slightly wider. Bury’s values were lower than England average from 2014/15 to 2015/16 and 2018/19 to 2020/21. Throughout this period, Bury value was higher than England average for the period 2016/17 and 2017/18. Both Bury and England experienced fluctuations in the percentage of persistent absentees over the years, but Bury's range of values was higher, suggesting a larger difference between the lowest and highest percentages (Figure 28). There was no data for 2019/20.

Figure 28: Persistent absentees - Primary school (%) for Bury and England from the period 2014/15 to 2022/23 (Child and Maternal Health, 2024)

Bury has the 4th highest proportion of persistent absentees in primary school in its group of 6 statistical children service neighbours with the highest percentage in Sefton at 16.4% and lowest in Lancashire at 14.4%. The recent trend for all statistical children service neighbours is increasing and getting worse (Child and Maternal Health, 2024).

There are no data on inequalities in Bury.

Data for England are available by ethnic groups, deprivation, special educational needs (SEN) status, first language status, eligibility for free school meals and sex.

Analysis of data for England by ethnic groups reveals Asian (5.9%), Mixed (12%) and Chinese (15.3%) ethnic groups have the lowest proportion (statistically significant when compared to England average) of persistent pupil absentees in primary school and the highest proportion (statistically significant compared to England average) are in White (21.6%) and Unknown (21.4%) ethnic groups.

Inequalities are also observed by levels of deprivation with the increasing persistent pupil absentees in primary school with increasing levels of deprivation. The highest pupil absentees are in the most deprived decile (20%) and lowest in the 2nd least deprived decile (13.6%).

Children with SEN support (24.8%) and EHCP or statement (31%) have a higher proportion of pupil absentees (statistically significant compared to England average). Children with no identified SEN have a lower proportion of pupil absentees (statistically significant) at 13.8%.

Inequalities are also observed by first language status in proportion of persistent absentees in primary school with those whose first language is not English have a statistically higher proportion (19.2%) of absenteeism in primary school. In contrast, pupils whose first language is English have a lower proportion of absenteeism at 15.3% (statistically significant).

Data by eligibility for free school meals in 2021/22 suggests that 30.7% of children eligible for free school meals (statistically worse than England average) have persistent absenteeism in primary school compared with 13.1% (statistically better than England average) of children who are not eligible for free school meals. Data for 2022/23 is not available.

Data by sex suggests that persistent absenteeism in primary school is slightly higher in males (16.7%) compared with females (15.7%).

Persistent absentees – Secondary school

This indicator is defined as percentage of secondary school enrolments classed as persistent absentees (defined as missing 10% or more of possible sessions).

Persistent absentees in secondary schools in Bury based on the most recent data from 2022/23 was at 26.8%, similar statistically to the England average of 26.5%.

The percentage of persistent absentees in secondary schools in Bury showed some fluctuations over the years. The lowest percentage was 11.9% in 2015/16 and the highest percentage was 16.0% in 2016/17. The percentage then decreased to 15.3% in 2017/18 and remained relatively stable at that level in the subsequent years, with 15.0% in 2018/19 and 15.3% in 2020/21. However, for 2021/22 the figure jumped to 27.6%, almost double the previous period, decreasing slightly to 26.8% in 2022/23.

Similarly, the percentage of persistent absentees in secondary schools in England also showed minor fluctuations. The lowest percentage was 13.1% in 2015/16 and the highest percentage was 13.9% in 2017/18. The percentage then decreased slightly to 13.7% in 2018/19, before increasing to 14.8% in 2020/21. Similarly to Bury, the England percentage almost doubled in 2021.22 to 27.7% in 2021/22, also dropping slightly to 26.5% in 2022/23, the latest period.

Bury generally had a slightly higher percentage of persistent absentees compared to the national average for England. Bury's values were lower than the England average from 2014/15 to 2015/16 and remained higher than England average from 2016/17 to 2018/19. The rates were statistically similar for 2020/21 to 2022/23. The trend is increasing and getting worse (Figure 29). There is no data for 2019/20.

Figure 29: Persistent absentees- Secondary school (%) for Bury and England from the period 2014/15 to 2022/23 (Child and Maternal Health, 2024)

Bury ranked 5th highest in terms of the proportion of persistent absentees in secondary schools among its group of 6 statistical children service neighbours. The highest percentage was observed in Sefton at 30.5%, while the lowest was in Stockport at 24.6%.

Inequalities in persistent absenteeism were observed across different factors. Analysis of data for England by ethnic groups revealed that the Asian (6.2%) and Mixed (16.7%) ethnic groups had the lowest proportion of persistent absenteeism in secondary schools (statistically significant when compared to the England average), while the Unknown (32.2%) and Black (28.7%) ethnic groups had the highest proportion (statistically significant compared to the England average).

Inequalities were also observed by levels of deprivation, with higher levels of deprivation associated with increasing levels of persistent absenteeism. The most deprived decile had the highest proportion of persistent absentees at 30%, while the least deprived decile had the lowest at 23.8%.

Children with SEN support (39%) and EHCP or statement (39.1%) had a higher proportion of persistent absentees (statistically significant compared to the England average). In contrast, children with no identified SEN had a lower proportion of persistent absentees (statistically significant) at 23.8%.

Inequalities were also observed by first language status, with pupils whose first language is not English having a statistically lower proportion (23.3%) of absenteeism in secondary schools. In contrast, pupils whose first language is English had a higher proportion of absenteeism at 27.2% (statistically significant).

Data by eligibility for free school meals for 2021/22 (no data available for 2022/23) suggested that 45.3% of children eligible for free school meals (statistically worse than the England average) had persistent absenteeism in secondary schools compared to 22.3% of children who were not eligible for free school meals (statistically better than the England average).

Data by sex indicated that persistent absenteeism in secondary schools was slightly higher in females (27.8%) compared with females (25.3%).

Special Educational Needs

The Children and Families Act 2014 provides the statutory basis for the system for identifying children and young people (age 0-25) in England with special educational needs (SEN), assessing their needs and making provision for them. The statutory Special Educational Needs and Disability (SEND): Code of practice, first published in 2014, sets out detailed information on the support available for children and young people aged 0 to 25 under the 2014 Act. Broadly, there are two levels of support:

• SEN Support, provided to a child or young person in their pre-school, school, or college.
• Education, Health and Care Plans which provide a formal basis for support for children and young people who need more support than is available through SEN Support.

There are 4 broad areas of Special Educational Needs, these are:

1. Cognition and Learning

This includes children with Specific Learning Difficulties, Moderate Learning Difficulties, Severe Learning Difficulties and Profound and Multiple Learning Difficulties.

2. Communication and Interaction

This area of needs includes children with Autism Spectrum Condition and those with Speech, Language and Communication Needs.

3. Social, Emotional and Mental Health

This includes any pupils who have an emotional, social or mental health need that is impacting on their ability to learn.

4. Sensory and/or Physical Difficulties

This area includes children with hearing impairment, visual impairment, multi-sensory impairment and physical difficulties.

Over 1.6 million pupils in England have special educational needs (SEN) in 2024, an increase of 101,000 from 2023. This includes the number of pupils with an education, health and care (EHC) plan and the number of pupils with SEN support, both of which continue a trend of increases since 2016. The percentage of pupils with an EHC plan has increased to 4.8%, from 4.3% in 2023. The percentage of pupils with SEN (SEN support) but no EHC plan has increased to 13.6%, from 13.0% in 2023. The most common type of need for those with an EHC plan is autistic spectrum disorder and for those with SEN support is speech, language and communication needs.

Percentage (%) of school pupils with special educational needs

This indicator is defined as the number of school children who are identified as having special educational needs expressed as a percentage of all school pupils. According to the latest school census data from 2024, 18.1% of the school population in Bury were in receipt of SEN support. This is just slightly lower than the national figure (18.4%), although this headline figure disguises a disparity between Primary and Secondary school age children. More children are identified as needing SEN support in Bury Primary schools than in similar local authorities (3.4% more), while SEN support in Secondary schools is at levels 15% less than in similar authorities.4.4% of Bury’s school population had an EHCP, compared to 4% nationally.

It is important to note that not all the children resident in Bury with an EHCP will be attending Bury schools.

The number of EHCPs for Bury children, when scaled per head of population is substantially Did higher than national, regional or similar authority averages – typically between 20% and 25% in each of the last 5 years of nationally published data, with a slight narrowing of the gap over the five-year period.

Bury’s age distribution for EHCPs is interesting, with a higher rate than comparators for all age bands, but particularly marked in the under 5s (double the national rate). Primary school age children are 10% higher than the rate for England, while Secondary school age children are 10% and post 16 are almost 40% higher.

Analysis of the characteristics of children with SEND rests on the school census collected by the DfE and the children and schools covered by the census. Unfortunately, the SEN 2 return has not included ethnicity or sex or any other characteristic beyond age. Since SEN Support is mainly used by mainstream Primary and Secondary schools to identify children in need of further support, the coverage for these children is good. However, coverage in the school census for children and young people with EHCPs is not as comprehensive. For example, the school census in 2022 included 1,313 children in Bury schools with an EHCP, 63% of all the children for whom Bury holds an EHCP (2,087), according to the SEN 2 data return. Similarly, nationally, the school census covers 70% of all the children and young people with an EHCP. This is because the school census does not include children with EHCPs who are not in schools. It is also worth noting that the school census covers children in Bury schools, not Bury children. So, for EHCPs, the analysis needs to be regarded as indicative not definitive.

Analysis of the ethnicity of children in Bury’s schools overall, compared with children with identified SEND reveals a pattern of slight over-representation of White British pupils in the EHCP cohort; and slight under representation of most other groups, especially children of Pakistani heritage. This pattern increases for children supported at SEN support. This is the area of SEND with greater discretion at school level. It is particularly marked at Secondary school, although some caution needs to be exercised in arriving at general conclusions, as it could reflect individual school practice.

Percentage (%) of school pupils with social, emotional and mental health needs

According to the National Clinical Practice Guidelines issued by the British Psychological Society, children who have learning difficulties or physical disabilities are more likely to develop mental health issues when compared to the general population.

This indicator is defined as the number of school children with Special Education Needs (SEN) who are identified as having social, emotional and mental health as the primary type of need, expressed as a percentage of all school pupils.

Percentage (%) of school pupils with social, emotional and mental health needs in Bury based on the most recent data from 2022/23 was at 3.5%, similar (statistically) to the England average of 3.3%.

The percentage of school pupils with social, emotional and mental health needs in Bury ranged from the lowest at 2.1% in 2015/16 and 2016/17 to the highest at 3.6% in 2021/22. In Bury, the percentage of school pupils with social, emotional and mental health needs remained relatively stable at 2.1% in 2015/16 and 2016/17. It then increased to 2.4% in 2017/18 and continued to rise in subsequent years, reaching 3.6% in 2021/22. It decreased very slightly to 3.5 in the latest period, 2022/23. The percentage of school pupils in England with social, emotional and mental health needs showed minor fluctuations. The percentages remained at 2.3% in 2015/16 and 2016/17, increased to 2.4% in 2017/18 and continued to rise gradually in the following years, reaching 3.3% in 2022/23.

Bury had a lower percentage of school pupils with social, emotional and mental health needs (statistically better) compared to England average from 2015/16 to 2016/17. From the period 2018/19 to 2021/22, the percentage in Bury remained higher (statistically worse) compared to England average. In 2022/23 it is statistically similar. (Figure 30)

Data based on the five most recent data point suggests that the trend in Bury is increasing and getting worse.

Figure 30: Percentage of school pupils with social, emotional and mental health needs for Bury and England from the period 2015/16 to 2022/23 (Child and Maternal Health, 2024)

Bury ranked 2nd highest in terms of the proportion of school pupils with social, emotional and mental health needs among its group of 6 statistical children service neighbours. Stockport was the highest at 3.6% and the lowest proportion was in Calderdale at 2.4%.

Inequalities in proportion of school pupils with social, emotional and mental health needs were observed across different factors. Data for Bury are available by age, categorised by primary and secondary school ages and sex. Analysis of data for Bury by age revealed that higher proportion of secondary school age pupils (4.1%) had social, emotional and mental health needs compared with primary school children at 3.0%. Inequalities by sex for Bury show Males, at 4.5%, have a higher proportion of school pupils with social, emotional and mental health needs than Females (2.4%). Males are statistically worse and females are statistically better than the Bury benchmark.

When examining the data for England by age, it was observed that secondary school age pupils (3.5%) and primary school children (2.8%) had fairly similar proportions of social, emotional and mental health needs. Inequalities by sex for England show Males at 4.4% and Females at 2.1%, very similar to Bury.

Inequalities were also evident when considering levels of deprivation. No data are available for the period 2022/23 but for 2021/22 the highest proportion of school pupils with social, emotional and mental health needs was in the 5th less deprived decile at 3.2%. This is followed by the 4th more deprived decile at 3.2% and both the most and 2nd most deprived deciles at 3.1%. The 5th more deprived decile had the lowest percentage of school pupils with social, emotional and mental health needs at 2.8%, followed by the 4th and 3rd less and 2nd least deprived deciles all at 2.9%.