Nottingham Insight

Introduction

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.

Smoking

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.

Data

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.

Jean Robinson, Strategic Intelligence, Nottingham City Council

Rachel Sokal, Consultant Public Health, Nottingham City Council