Good mental health during early years and childhood has a great bearing on health throughout life. By contrast, poor mental health can cast a long shadow. Consequences may include depression, self-harm, and poor physical health. Services recognise this. They aim to provide access to support in a timely and suitable way. A national target has been set, namely that 35% of children and young people with diagnosable needs should be able to access the necessary services. But there is some way to go. There has been an increasing focus on young people’s mental health, which appears to be poor relative to comparable nations and the recent past. So, to gain a clearer sense of need, and patterns of access to services, the Strategy Unit has undertaken specific analysis for the 11 Integrated Care Systems (ICSs) in the Midlands. This is another significant analytical project for the Midlands Decision Support Network. The ICS have further evidence to understand and address the problems in their area. Our findings 1. Services are struggling to keep pace with existing demand In the Midlands there are an estimated 350,000 children and young people with a range of mental health needs. At present, only 43,000 of these are receiving some kind of specialist support. Identifying the children and young people who most need support is difficult, with health and care professionals finding it increasingly challenging to reach those concerned. When they do, there is simply not enough support available. For example, our research found that only 2% of the estimated 160,000 children and young people in the Midlands with eating disorders are finding their way to specialist support. 2. There is wide variation in access to services in the region Even the better-performing areas are only able to provide the necessary support to 30% of those who need it. Children and young people who are Black / socially deprived / aged 18 to 24 / have learning disabilities or autism, tend to struggle more with accessing appropriate support. Health and care professionals suspect that services are not being provided equitably, but current data doesn’t provide clear enough evidence of this. 3. Access targets are a necessary focus, but there needs to be more meaningful analysis on who is, and who should be, using existing services ICSs need to measure what they are proposing to change. Without the correct data and subsequent analysis, this will prove almost impossible. 4. Routes into and through services need to be clearer Those that need support often don’t know how to access it. Health and care professionals acknowledge that those better able to navigate the complex services, for example through parental advocacy, tend to have an advantage in accessing support. 5. Children and young people should be involved in improving services There is limited involvement of young people in improving services. Mental health and care professionals also want this to happen more. Conclusions There is no single or quick fix to the problems highlighted in the research. Evidence suggests that the pandemic will have placed an even greater strain on already stretched services. Children and young people, as well as professionals, deserve these services to be given far greater priority, as well as improved resources. Especially at a time of stretched resources, ‘fixes’ on this scale are not straightforward. This is a long-term, cross-societal challenge: how much do we value young people’s mental health? This question is well outside the scope of our work. So we have focused our recommendations on more achievable improvements that are within current services’ control. They are to: Collect better data and use it Services could improve data collection around aspects of inequity and access. Greater precision is needed. Datasets in primary care, education, social care, criminal justice, and specialist services could all be linked. All data should be disaggregated by gender and ethnicity. Services could consider an investment in analysis and learning from the data, as well as needs assessments. Measure, monitor and maintain All new initiatives and interventions should be robustly evaluated, for equity as well as efficacy. It is essential that we all learn what works in what circumstances and that it is shared systematically. Establishing a serious learning system will inform the development and adaptation of promising service improvements; it will also provide evidence to stop any services that are not working and allow resources to be redirected. Co-design and co-produce Children and young people deserve to be meaningfully involved in their services, and their voices should be heard. A rollout of targeted engagement programmes would provide a way of reaching them. The detail: The full report is here. The evidence map is here. A webinar exploring findings can be viewed here. ICS level data on unmet needs and pathway inequalities are listed below:

Dementia is a key priority for NHS England and is estimated to affect around 676,000 people in the country. Our analysis is intended to help understand the need for future dementia diagnosis and treatment services in a specific area and to help commissioners to identify and prioritise interventions.

Neurosciences encompasses a large number of services and interventions, delivered to individuals with a wide range of conditions by numerous providers in many settings. Describing the full range of patients, interventions and services will provide those who work in and support NHS commissioned neurosciences with the context required to holistically assess, plan and improve these services. This report identifies six analytical priorities for clinical neurosciences in England. We hope the report contributes to the development of a national strategy for clinical neurosciences and will provide a clear steer for those delivering analytical services in this area. The report was developed at the request of and with the involvement of Professor Adrian Williams, Chair of the Neuroscience Clinical Reference Group (CRG) and the National Neurosciences Advisory Group (NNAG)

Early in the Covid pandemic, it became clear that people’s mental health would suffer. Whether through bereavement, unemployment, social isolation, not being able to access support services – or a host of other routes – an alarming picture began to emerge and attract attention. The detail of this picture has become progressively clearer. Press reports, population surveys, stories from service users and staff; evidence has emerged and accumulated. We are gaining an increasingly refined understanding of exactly how bad the pandemic has been for the nation’s mental health. Against this background – and as part of a national analytical collaboration – the Strategy Unit has produced a model to help local services plan their response. Using this model, we estimate that: There will be around 11% more new referrals to mental health services, each year for the next three years; and Associated costs amount to an extra £1 billion a year. This is around 8% of annual NHS expenditure on mental health services. Moreover, these figures are in addition to the approximately 500,000 people that were not able to access services during the first national lockdown. These headline results are shocking. They are useful for seeing the scale of coming demand and for attracting appropriate attention.

We see all analysis as informing decisions. Producing high-functioning analytical teams able to design and produce high-quality analysis, and communicate it effectively to decision-makers, is therefore essential. The Strategy Unit were asked by the Strategy and Development Team in the Directorate of the Chief Data and Analytics Officer, NHSE/I, to make recommendations for advancing analytical capability across the health and care workforce. To do so, we consulted a wide range of colleagues on the questions: how do we advance analytical capability? What does high-quality analytics look like? What are the implications for skills, career paths and training? The report responds to each of these questions. It describes how analysts, teams, regions and national bodies can: organise themselves to deliver strategic analysis; develop their analytical skills and provide opportunities to simplify career pathways for analysts; appreciate and utilise the full range of analytical possibilities at their disposal; and connect with peers through networks. The report is part of a growing effort across health and care to get the most out of our analytical workforce, and provide opportunities and options for individual analysts. It builds on recent work to develop a competency framework for healthcare analysts by AphA, and informs the upcoming guidance and toolkit from NHSE/I and the Strategy Unit on building cross-system intelligence functions. Alongside the full report, a separate document outlines what career pathways for healthcare analysts might look like, and the resources available to them to advance their skills.

People living in deprived areas develop coronary heart disease and die at a younger age than their counterparts living in other areas. In recent decades, significant progress has been made in reducing deaths from coronary heart disease, by lowering the prevalence of certain risk factors, such as smoking, by improving the consistency of disease management, and by introducing new diagnostic, pharmacological, and surgical interventions. Whilst these improvements have benefitted all socio-economic groups, relative differences in premature cardio-vascular mortality rates have increased. Addressing this problem is not straightforward. Part of the challenge for health systems is knowing where to target their efforts. Should it attempt to reduce these inequalities by improving access to preventative interventions, or by improving disease detection, or by improving treatments once a disease has been diagnosed? Our new tool, developed for and with the British Heart Foundation aims to help Integrated Care Boards (ICBs) with this challenge. In a single chart, ICBs can get an overview of the points on the care pathway where inequalities emerge and are amplified. The online tool brings information together from many sources and presents it in a novel, intuitive, visual format. We hope the tool proves useful and welcome feedback on how it can be improved.