Nottingham Insight

Students (2016)

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Topic title Students (2016)
Topic owner Hugh Porter
Topic author(s) Jean Robinson
Topic quality reviewed February 2016
Topic endorsed by Student JSNA working group, January 2016
Topic approved by Student JSNA working group
Current version February 2016
Replaces version 2012
Linked JSNA topics
Insight Document ID 164166

Executive summary


University students make up a significant proportion of Nottingham City’s population and are increasing in number.  Their health needs have been assessed in partnership with the two universities and associated healthcare commissioners.  The scope of this chapter covers students studying at either The University of Nottingham or Nottingham Trent University in full time or part time undergraduate and postgraduate ‘higher’ education on any University campus across the city and county.  It includes students from the UK and overseas, those who originate from Nottingham and those who have moved to Nottingham to study.  Students at the China and Malaysian campuses of the University of Nottingham are not included in this work. 

Students have their own discrete preferences and constraints in terms of accessing services, preferred communication channels and identity.  It is for these reasons that they are considered specifically here, rather than in each of the topic specific chapters. 

Although generally in good health, students have particular health needs in terms of mental health, sexual health, smoking, alcohol and drug use and physical activity.  There are also issues relating to access to health services, particularly for international students, who may be living in the UK for the first time and around the challenges of integrating large student populations into local communities.

There are separate chapters in the JSNA which consider alcohol, smoking, diet and nutrition and physical activity.   Health needs of young people in general (including those in further education) in Nottingham are considered within the JSNA under specific topic areas e.g. mental health, sexual health and substance misuse.

The university support services and specialist GP practices have built up a considerable body of knowledge about student health and wellbeing needs.  Given that the student population makes up a significant proportion (15%) of Nottingham City’s population, it seems reasonable that this expertise should be drawn upon commissioning the mainstream services that students may access.  

Unmet needs and gaps

What has changed since 2012?

  • A new Eating Disorder in Students Service (EDISS) has been commissioned by Nottingham City CCG. EDISS is an education, assessment and treatment service, supporting early identification and intervention for mild to moderate eating disorders. The Service provides targeted and accessible ‘drop-in clinics’ located on the main campuses of Nottingham Trent University and the University of Nottingham.
  • C Card registration has been aligned across City and County so that all young people up to age 24 years can access the service.
Unmet need and gaps

A significant proportion of Nottingham City’s population are students in higher education.  Whilst there is a common view that students are a relatively healthy population, there are characteristics of being a student in particular that may have a hidden impact on long term health outcomes if not managed appropriately.  In addition it is important to ensure as far as possible that a student who has started a course at university, but who is at risk of dropping out, is supported to continue, given the positive association of higher educational achievement and better long term health outcomes.

The characteristics of the student population that may impact on their health outcomes are as follows:

Continuity of care

Students often live away from the family home during term time but move back home during vacations.  These transitory living arrangements make accessing mainstream services more complicated.  There are challenges of ensuring continuity of care between ‘home’ and university providers, particularly in terms of the management of chronic conditions such as mental illness, and it would be helpful if there were flexibility around waiting times and appointments that acknowledge the university timetable.  University support services from both Nottingham Trent University and the University of Nottingham report that often students are offered appointments during vacation times when they would ordinarily return home, or that appointments are not flexible enough during for example exam periods.  In addition, there are times when the duration of an intervention exceeds a semester, resulting in either curtailed treatment or having to start the referral, assessment and treatment process again in their ‘home’ location.

International students

There is a high proportion of students from overseas who may not fully understand how to access services in the UK or who may have cultural reasons for not wanting to, nor feel able to access services.  There is some evidence that international students are under-represented in counselling services data for example and the 2011 Mental Health Needs Assessment undertaken at the University of Nottingham[i] indicated that there are barriers to accessing mental health support for international students and in particular those from China.  For these students the tutor and academic staff support system is often seen as a more acceptable source of support but may not be the most appropriate.

Immunisation and vaccination

The close living arrangements of students means that infection control measures need to be given careful consideration.  This includes access to vaccinations and screening as well as having outbreak management plans in place. There does not appear to be a system for ensuring MMR catch up for students studying at campuses outside the City.  MenACWY vaccination is currently done on a good-will arrangement across the City practices. International students in particular may not have been routinely vaccinated in their country of origin. Students arriving from countries with higher incidence of disease such as TB need to be identified and immunised.

Registration with GP practices

The new academic year presents a significant amount of work for the main student GP practices.  Up to one third of the practice list will leave at the end of the academic year and there will be up to one-third new patients that register at the beginning of the academic year.  This mass-registration process again adds a layer of complexity to the assessment of health needs.  Firstly, not all students will re-register with a GP in Nottingham when they leave home to study.  There is some evidence to suggest that this may be particularly true of students with long term or enduring conditions.  In addition, for those that do register in Nottingham, this busy period means that the needs of more vulnerable students may be overlooked. Although the majority of students are registered with one of three city practices serving the student population, a significant number will be registered with other practices in which they will not form a clearly identified sub-group, for instance students living at home in Nottingham that have stayed with their family practice and students at the satellite campuses in the county. It is important that these practices ensure the students under their care have good access to services open to students and that their immunisation histories are up to date.

Sexual Assault

National research commissioned by the National Union of Students[ii] provided some evidence that sexual harassment and assault were an issue, particularly for female students. There is very little information on the extent of the problem locally or on the services available to tackle the issue.


Students appear to have a low uptake of smoking cessation services based on a Health Equity Audit in 2015[iii] and there has been a withdrawal of smoking cessation outreach support to the university campus health promotion events.

Alcohol and drugs

The prevalence of high alcohol consumption in student populations and the impact on student activities such as Welcome Week on the Nottingham night-time economy are significant.  Research evidence suggests students are more likely than non-students to use ketamine. Data from Mosaic indicates that students are more likely to take cannabis and cocaine.


Whilst undertaking this health needs assessment it was often the case that data on students was not specifically available.  The current methods of using registration at the main GP practices and Mosaic segmentation to identify the student population presents limitations in terms of sensitivity of the data.

[i] Mental Health Needs Assessment of Chinese and Malaysian Students undertaken at the University of Nottingham, 2011

[iii] Health Equity Audit of New Leaf Smoking Cessation Service , Nottingham City Council, 2015

Recommendations for consideration by commissioners

  1. Establish commissioning links between the University Support Services (at the University of Nottingham and Nottingham Trent University), Nottingham City CCG and Nottingham City Council in order to secure a wider perspective on service planning and delivery.Formalising a closer working relationship between the universities, local commissioners and providers of healthcare and Nottingham City Council in these areas is likely to be beneficial.  This would ensure appropriate input when developing specific health strategies such as alcohol, smoking and mental health, would assist in the planning of services at key times that impact on Nottingham as a whole, such as Welcome week and would ensure appropriate input into community planning areas such as housing.Mainstream care pathways do not currently acknowledge students as a specific group with needs in terms of timing of appointments, continuity of care across the academic year and cultural differences with the international students.  This is most pressing in the area of mental health services including treatment for eating disorders but also for sexual health, smoking cessation and alcohol harm reduction services.
  2. CCGs to consider how differences in service availability experienced by students registered with practices in Nottinghamshire County and Nottingham City could be taken forward.Whilst each university considers its registered students as a single population, in practice the student populations fall into different local authorities and CCG footprints.  Whilst the majority of students study and are registered with GPs in Nottingham City, a significant proportion study at two campuses in Nottinghamshire County i.e. Sutton Bonington and Brackenhurst and may therefore register with GPs in Rushcliffe CCG and Newark and Sherwood CCG. The JSNA process could support commissioning by considering the needs of students as a specific population group in all relevant chapters.  
  3. Discussions with stakeholders at the two universities highlighted the need for improved communication between in-house university mental health advisors and counselling services and mainstream mental health services regarding service venues, clinic times, waiting list times and interventions offered.  Universities would benefit from more effective communication from external services about changes to service provision and access.  With on-going re-commissioning and restructuring of services, this is a particular difficulty. The mental health services at the two universities do not feel that they have enough information to give to students who need to be referred to mainstream mental health services about what is available, when and where, particularly since mainstream services have been re-commissioned.
  4. When commissioning services for student populations, the CCG should ensure equitable access across the two universities going forward. The benefits of extending the TB screening programme for new entrants to Nottingham Trent University should be considered.
  5. A systematic procedure for ensuring all students have a complete immunisation history needs to be developed, particularly in relation to the MenACWY vaccine introduced in August 2015.
  6. The recommendations from the Mental Health Needs Assessment of Chinese and Malaysian students[i]should continue to be incorporated in how both Universities engage with International students. This was a significant piece of work and highlighted important issues related to access to mental health services for students.
  7. All partners, including the Nottingham City CCG, Nottingham University Hospital, the main student GP practices, EMAS and University Support Services should consider a mechanism for ensuring that better health intelligence about the student population is available for future needs assessments. Future health needs assessments would be enhanced with more specific data regarding the student population.  This could be made easier if there was a way of identifying individuals as students in routine data, by for example adding a ‘student tag’ (Further Education and Higher Education) in primary, secondary and tertiary care or by planning new data collection to capture student-specific needs for example through cross sectional surveys.  Consideration could be given to the development of a demographic dataset provided by the universities containing age, gender, postcode, country or UK postcode of origin and ethnicity as a basis for future needs assessments.
  8. The University of Nottingham and Nottingham Trent University should continue to provide culturally-appropriate information for home and international students about how to access health services in England and what health services are available and this should be supported by the local health services. In addition, students should be encouraged to register with a local (Nottingham) GP practice in line with NHSE recommendations.
  9. Both Universities should continue to raise awareness of alcohol and drugs harms and ensure students are able to easily access appropriate services. In addition, a review of the extent of sexual harassment including prevalence, level of reporting and services available is recommended with development of integrated and comprehensive interventions targeting young people in the university setting.
  10. There is a need to ensure other relevant JSNA chapters consider students as they form such a significant section of our population to ensure that commissioning decisions consider the term-time / continuity problems encountered by students.


[i] Mental Health Needs Assessment of Chinese and Malaysian Students undertaken at the University of Nottingham, 2011

Key contacts

Jean Robinson, Strategic Intelligence, Nottingham City Council

Rachel Sokal, Consultant Public Health, Nottingham City Council

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