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Working Together to give Children and Young People a Healthy Start

Professor Viv Bennett Director of Nursing DH and PHE

Population Health – the waves of public health

• 1st wave – public health works, such as clean water, sewers, drains • 2nd wave – discovery of antibiotics, early vaccines, and the ability to treat and prevent infections • 3rd wave – development of the welfare state and the NHS, tackling the Beveridge Report’s “five giants” – disease, squalor, ignorance, want and idleness [unemployment]. • 4th wave – addressing the perils of tobacco, and then other lifestyle related non-communicable diseases 5th wave – is the one that we are just entering and have the opportunity to shape includes • looking behind inequalities and • greater understanding of the social determinants of health .

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Children and Young People’s (CYP) health: variation Smoking in pregnancy Preventable Infant Mortality MMR immunisation (by age 2 years) Killed/seriously injured in road accidents Obese children (4-5 years) Hospital admissions due to alcohol specific conditions A&E attendances (0-4 years) England Best

2.9

2.2

97.2

4.4

5.8

16.9

136.3

England Average

13.2

4.4

91.2

22.1

9.5

55.8

483.9

England Worse

29.7

8.0

78.7

47.9

14.5

138.3

1,187.4

3 Source: Child and Maternal Health Intelligence Network, PHE, May 2013 Public Health Nursing and Midwifery

CYP and Families: a life course approach (1)

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Marmot 2010, Fair Society, Healthy Lives: The Marmot Review

CYP and Families: a life course approach (2)

Pregnancy Reduce numbers of still births and infant deaths Early Years Safe transfer of Healthy Child Programme 0-5s School-aged Adolescents Settings approach – healthy schools and FE Reaching C&YP out of school NCMP Adolescent public health improvement framework – targeting children & young people with multiple vulnerabilities Improving health outcomes Working with early years school years PH professionals and partners Healthy weight and tackling childhood obesity Troubled Families Early Intervention Reduce number of children under 18 killed in road traffic accidents Promote resilience/ improve mental health and wellbeing Ensure children, young people & families shape, inform and hold PHE to account 5 Public Health Nursing and Midwifery

A healthy start – evidence based services

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Healthy Child Programme (HCP): the best start for all children and extra help where needed Universal

• Health and development reviews • Screening and physical examinations • Immunisations • Promotion of health and wellbeing, e.g.: 1.

– smoking 2.

– diet and physical activity 3.

– breastfeeding and healthy weaning 4.

– keeping safe 5.

– prevention of sudden infant death 6.

– maintaining infant health 7.

– dental health •

Promotion of sensitive parenting and child development

•

Involvement of fathers

• Mental health needs assessed •

Preparation and support with transition to parenthood and family relationships

•

Signposting to information and services Universal plus

• Emotional and psychological problems addressed • Promotion and extra support with breastfeeding • Support with behaviour change (smoking, diet, keeping safe, SIDS, dental health) • Parenting support programmes, including assessment and promotion of parent– baby interaction • Promoting child development, including language • Additional support and monitoring for infants with health or developmental problems • Common Assessment Framework completed

Higher risk

• High-intensity-based intervention • Intensive structured home visiting programmes by skilled practitioners • Referral for specialist input • Action to safeguard the child • Contribution to care package led by specialist service SAFEGUARDING 7 Public Health Nursing and Midwifery

Key roles for nurses midwives health visitors from early days of public health

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Health Visiting (HV) Programme Govt committed to 4200 more HVs by 2015 to improve access, support, experience and outcomes for children and families The total number of health visitors from the HV MDS at May 2013 is 9,149 wte. 2,526 students began HV training in 2012/13 (includes RtP) Over 250 transformational projects delivered by our 49 HV early implementers over two years (of which) 65 Supporting professionals, individual, team and technology

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HV Programme: priorities for transformed services Service model being implemented through EIS Programme, support to commissioning and HV services, leadership events and professional mobilization programme.

Improving access to the HCP, uptake of services and health outcomes for children and families with an early focus on Assessing and responding to local need (‘population health’) Transition to parenthood: Pregnancy and the early weeks Two to two and half years Ready for school: (HV to School Nursing Pathway) Families access/experience of services

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HCP: protecting health - immunisation Importance of HCP immunisation programme Resurgence of childhood illnesses when immunisation rates fall – whooping cough (pertussis), measles Flu – protection in pregnancy Protection before immunisation programme – pertussis for pregnant women

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Assessing and responding to local need (‘population health’)

Assessing and responding to local need , including building community capacity and pathway development Predicted Population level e.g. PREview

Types of Need

Assessed by HV/ScN (or others involved with family) Expressed by Family/young person

Health Visitor/School nurse

12 Provide service/ service contribution with partners Children’s Centres/ Schools Public Health Nursing and Midwifery Delegate to Team member Signpost e.g.

Children’s Centres/ youth services

Service Response

Refer on

Transition to parenthood

Pregnancy and the Early Weeks, including antenatal contacts and 3-4 month review

Improving Family Experience

Parenting Support programmes .

“As a father I felt very involved in the sessions, and understand how to support my partner and baby.” !

13 Public Health Nursing and Midwifery “I really feel that I understand about how my baby is developing, and how I can help their development, it’s amazing.”

Two to two and half year review

Improving two to two and half year review including 20 sites DfE joint working with health visitors including the two year integrated review 14 Public Health Nursing and Midwifery

Ready for school: HV to School Nursing Pathway Ready for School Projects

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Key issues facing school age CYP

  

.6ences were for over 25 days (2010) 22.6% of all school absences were for over 25 days (2010) 9.6% of children aged 5-16 years had a clinically recognisable mental disorder (2005)

   

11% of boys and 8% of girls reported current asthma symptoms (2010) There are 139,000 young carers aged under 18 in England (2001) 16% of children aged 2-15 were classified as obese (2010) Around one third of children have at least one decayed, missing or filled tooth (30.9% at 5 years old and 33.4% at 12 years old)

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173,416 new cases of Chlamydia in the 15-24 age group (2010) 4% of boys and 5% of girls attending school described themselves as regular smokers (2011)

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12% of 11-15 year olds reported having had alcoholic drink in the past week (2011)



7,400 under 18 pregnancies (first quarter of 2011)

School nursing (ScN) development programme

Programme developed with profession and CYP Community Universal Services Universal Plus Universal Partnership Plus School Nursing Vision http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133352.pdf

Published pathways and fact sheets http://vivbennett.dh.gov.uk/public-health/ 17 Public Health Nursing and Midwifery

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Strengthening the school health service offer Leadership at all levels

Early support to avoid crisis’ ‘Support at times when I need it most’ ‘To tell my story once

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Access including technology Partnership working Early support Commissioning to meet local priorities ‘Reaching out’ Identifying vulnerability

Visible – Accessible - Confidential

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School Nurse Programme - products

•Underpinning professional pathways which include: – Delivering public health to young people in the youth justice system – Supporting children with complex needs in school settings – Supporting young carers – Safeguarding – Emotional health and wellbeing – Sexual health •Suite of fact sheets: – Health and social care professionals – Elected members – Head teachers •Young people champions •National network •Supporting Young carers work stream •Social media network

Working in the now! Technology and social media

Improving access and reach using technology In synch with my life Right here –right now Apps Text Blogs Website Tele health Smarter working Welcome to my world The next generation 20 20

Success: Public Health Outcomes Framework (1) Healthcare public health and preventing premature mortality:

Infant mortality Tooth decay in children aged 5

Health protection:

Chlamydia diagnoses (15-24 year olds Population vaccination coverage

Air pollution

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Success: Public Health Outcomes Framework (2) Improving the wider determinants of health:

Children in poverty School readiness (Placeholder) Pupil absence First time entrants to the youth justice system 16-18 year olds not in education, employment or training

Killed and seriously injured casualties on England’s roads Domestic abuse (Placeholder) Violent crime (Placeholder) Utilisation of green space for exercise/health reasons Fuel poverty

Health improvement:

Low birth weight of term babies Breastfeeding Smoking status at time of delivery Under 18 conceptions Child development at 2 – 2.5 years (Placeholder) Excess weight in 4-5 and 10-11 years olds Hospital admissions caused by unintentional and deliberate injuries in under 18s Emotional well-being of looked after children (Placeholder) Smoking prevalence – 15 year olds (Placeholder) Hospital admissions as a result of self harm Diet (Placeholder) 22 Public Health Nursing and Midwifery

Success: what does look like?

Working together as partners and with families Resilient communities and reduced inequalities Improved outcomes for children and young people

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Email [email protected]

Tweet @vivjbennett

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