Transcript Document

Children and Young People
Health and Wellbeing in Greater
Manchester
Children and Young People
Health and Wellbeing - Overview
• Early Intervention and prevention – the circumstances in
which children grow up will influence their future health
and wellbeing.
• Changed roles and responsibilities in the NHS since 1st
April 2013.
• Significant variation in health and wellbeing outcomes for
children and young people.
• Use of health services - Greater Manchester has very high
rates of child emergency hospital admissions for longterm conditions.
• Transitions - arrangements for transition between
services for children and adult services can be
Early Intervention and
Prevention
Conception to age 2 –the age of opportunity
How we treat 0-2 year olds shapes their lives – and ultimately our
society.
Loving, secure and reliable relationships with parents, together
with a quality home learning environment foster a child’s:
•Emotional and mental wellbeing
•Capacity to form and maintain positive relationships with others
•Language and brain development (c. 80% developed by age 3)
•Ability to learn
WAVE Trust April 2013
Also see NICE Guideline 40
Early Intervention and
Prevention
Conception to age 2 –the age of opportunity – What we need to ensure:
Healthy pregnancy – reduced maternal stress, drug and alcohol misuse,
good diet
Adequate infant nutrition, particular benefit of breastfeeding
Good hygiene, home safety and immunisation
Earlier identification of need and provision of appropriate support
Intervene early to promote infant mental health
Full delivery of Healthy Child Programme with focus on promoting social
and emotional development
Targeted work in Children’s Centres
Quality provision in early years services and settings
Well implemented, evidence based preventative services and early years
interventions are likely to do more to reduce abuse and neglect than
reactive services AND deliver economic and social benefits.
Early Intervention and
Prevention
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GM Early Years New Delivery Model
Work is underway to develop:Single outcomes framework
8 Stage Assessment – standardised assessments used at key stages
from pregnancy to school, identifying needs and measuring progress
Evidenced based interventions – delivered routinely and at scale
Good use of Daycare, notably targeted two’s offer, with an
education, work and skills ‘contract’ for parents
Well equipped workforce from maternity to schools
Data systems that support practice and track impact
Long term evaluation
Ref Early Years Business Case Oct 2012
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NHS England
Public Health England/ Department of Health
NHS England – Local Area Team
Clinical commissioning groups/ local authorities public
health
• Local authorities
• Schools
• Police and Crime commissioner
Vision for a local Healthy Child Programme:
pregnancy to 19
Pregnancy to five
offer
5 to 19 years
offer
A ‘good’ local programme will
improve these key outcomes:
• Foundation Stage Scores – narrowing the
gap
• Infant mortality – LE gap
• Low birth weight
• Teenage pregnancy rate
• Childhood obesity
• Reduced A&E attendance & hospital
admissions
• Reduced vulnerability of individual children
Children and Young People’s
outcomes
The health and well-being of children and young people –
 Begins before birth
 Is affected by a range of factors including social, familial and
biological/physical
 Carries implications for later adult life
The following illustrates the GM position in relation to England on several
key measures: Red figures denote GM is worse and green denotes better
than England.
Pre-birth
GM
AVERAGE
#Conceptions (per 1,000 under 18yr olds: 2011)
37.8
MEASURE
*Infant deaths (per 100 live births carried to
term: 2009-2011)
^Mothers smoking at time of birth (per 100
births: 2012/13)
ENGLAND
AVERAGE
30.7
4.8
4.4
15.6
12.6
Sources: # ONS Conception statistics:* www.phoutcomes.info: ^
www.hscic.gov.uk
Wider determinants
MEASURE
~Lone
parent households (% of population:
2011)
$Children living in poverty (% of population:
2010)
MEASURE
&Domestic
violence (number of recorded
incidents: 2011/12)
GM
ENGLAND
AVERAGE AVERAGE
14.0
11.7
23.9
21.1
GM
ENGLAND
Total
745,105
47,496
(6% of England
total)
Sources: ~ONS 2011 Census: $ ChiMat: &ONS Crime Statistics
Outcomes
GM
AVERAGE
*School ready (% of population: 2011/12)
61.3
MEASURE
ENGLAND
AVERAGE
64.0
*Obesity at 4-5yrs (% of population: 2010/11 )
22.4
22.6
*Obesity at 10-11yrs (% of population:2010/11)
35.5
33.4
147.9
124.3
+Deliberate
and unintentional injuries under
18yr olds (per 10,000 <18yr olds: 2010/11)
Sources: * www.phoutcomes.info: + www.apho.org.uk
Levels of need
Low Numbers
High need
CPP
LAC
0.29%
0.48%
CiN
3.6%
Vulnerable
36%
High Numbers
Low need
69,000
All children
Primary Care
• Children and young people make up a significant
proportion of patients seen in primary care.
• Ensuring that primary care services are able to
communicate effectively with children and young people
is key to helping then manage their health.
• Children and young people need to be aware of the
services they can access and their right to universal
health services.
• For Children and Young People with long-term chronic
conditions communication with primary care is key to
good self management.
Secondary Care
• Greater Manchester has very high rates of child emergency
hospital admissions for long-term conditions.
• Rates of admissions for asthma and epilepsy are significantly
higher than the England averages.
• For asthma and epilepsy emergency admissions rates
increase as levels of deprivation increase – but there is no
relationship between deprivation and emergency
admissions for diabetes.
• When compared with statistically similar areas – many parts
of Greater Manchester have much higher rates of hospital
admissions.
Transition into Adult Services _
Barriers
• coordinated approach to transition,
including lack of multi-agency working
● lack of a holistic approach
● lack of information for young people and
parents
● insufficient attention to the concerns of the
young person
● lack of appropriate services onto which
young people can transfer.
Stockport A&E Pathway for Under
18’s
• Set up Dec 2010 in response to lack of referrals from local
A&E to Mosaic
• Paediatric Liaison Nurse screens attendances daily for
substance misuse attendances and refers to Mosaic
(treatment /school based worker)
• 175 referrals in first 18 months
• 41% at Stockport Schools & 96% of these were engaged in
intervention in school
• Remainder contacted by letter, with further active followup for higher risk cases
• Only 5 repeat attendances within first year
Trafford case study
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Trafford commissions Phoenix Futures who run an 11-25 YP service
Issues of drugs (mainly Cannabis) and alcohol used together by Young People
as a means of coping
Involving Young People in Care/Recovery Plans so they take ownership
Extended service from 11-25 means a range of risky behaviours can be
addressed in an holistic way
Encourage healthy lifestyles such as access to community facilities such as gym
and nutritional information
Structured use of time by affording access to college courses and work
opportunities
Dedicated PbR funnels ensure core areas within a YPs life are addressed via an
individualised care plan which considers offending and employment which will
impact on health of YPs
Access to Counselling services, where required
Consider mental health provision beyond 18 when CAMHS will cease and how
this may impact on YP misuse of alcohol and drugs.
The service have engaged in a number of prevention sessions within schools to
raise awareness
‘The true measure of a nation’s standing is how well
it attends to its children – their health and safety,
their material security, their education and
socialization, and their sense of being loved, valued
and included in the families and societies into which
they are born’
Child poverty in perspective:
An overview of child well-being in rich countries
UNICEF 2007
Group Exercise
• What needs to change to make the transition
between services work better for children and
young people?