Transcript Slide 1

ChiMat:
Looking forward: Challenges in
improving outcomes in maternity
and early years
Dr Helen Duncan
ChiMat Programme Director
June 2012
Maternal conditions
Hospital admission rates for maternal
conditions, 2010/11 (excludes admssions for delivery)
1,600
1,400
1,200
1,000
800
600
400
200
0
Abortion
Maternal
hemorrhage
Hospital Episode Statistics
Hypertensive
disorders of
pregnancy
Obstructed
labour
Maternal
sepsis
Maternal mortality
Percentage of maternal deaths due to direct and indirect causes, 2006-2008
Centre for Maternal and Child Enquiries, CMACE
Trends in infant mortality
Trend in infant mortality rate for the EU15
source: Eurosta
t
note: reported infant mortality rate for England & Wales for 2010 is 4
7.0
Belgium
Denmark
6.0
Germany (including former GDR from 1991)
5.0
Ireland
United Kingdom
Greece
Spain
4.0
France
Italy
3.0
Luxembourg
Netherlands
2.0
Austria
Portugal
1.0
Finland
Sweden
0.0
2001
2002
2003
2004
2006
3,700+
registered users
2005
2007
2008
20092,300+
2010
registered users
Infant mortality by socio-economic
group
3,700+
registered users
2,300+
registered users
Children and Young People’s Health
Outcomes Forum :Role
The Forum, jointly chaired by Christine Lenehan and
Professor Ian Lewis was launched on 26 January and
will be reporting to the Government with
independent advice later this year on:
– the health outcomes that matter most for
children and young people
– how well these are supported by the NHS and
Public Health Outcomes Frameworks
– how the different parts of the health system will
contribute and work together in the delivery of
these outcomes
The Health Reforms
•NHS commissioners supported by a new NHS
Commissioning Board will authorise CCGs, commission
some services including primary care, and host clinical
networks and senates
• Most NHS care commissioned by Clinical Commissioning
Groups
• All NHS providers to become Foundation Trusts
• A stronger role for local authorities in shaping services, with
new responsibility for local population health improvement
• New Health and Wellbeing Boards within each higher tier
local authority area
Children and Young People’s Health
Outcomes Forum; Engagement
•The Forum is organised by the following themes and leads:
– Public Health and Prevention: Ann Hoskins & Barbara Hearn
– Acutely Sick Children: Carol Ewing & Eric Kelly
– Mental Health: Lisa Christensen & Margaret Murphy
– Long Term Conditions: Colin Green & Gillian Baird
•National Children Bureau’s work to gather evidence on the views of children &
Young People
• National, regional and local events
• Focus Groups looking at specific issues and communities
• Online feedback via http://healthandcare.dh.gov.uk/category/children/
Maternal obesity
Prevalence of obesity among children by school year and sex
Obesity prevalence and deprivation
National Child Measurement Programme 2006/07 – 2010/11
National Child Measurement Programme 2010/11 – Year 6 children (aged 10-11 years)
Local Authorities in England
Year of m easurem ent
2006/07
2007/08
2008/09
30%
2009/10 2010/11
20.0% 20.0%
25%
20.4% 20.6%
R² = 0.56
16.6% 16.5%
17.0%
Obesity prevalence
19.0%
17.4%
15.8%
10.7% 10.4%
10.3% 10.5% 10.1%
20%
15%
10%
9.1% 8.8% 8.9% 9.2% 8.8%
5%
0%
0
Reception boys
Reception girls
Year 6 boys
Year 6 girls
Impact of maternal obesity
-
5 % BMI > 35
34% in most deprived quintile
Risk type 2 diabetes in BME 3.5 X
Risk gestational diabetes in BME 1.6 X
More C-sections in BME
More deliveries before 37 weeks in BME
CMACE 2010
20
30
40
50
Index of Multiple Deprivation 2010 score
(High score = more deprived)
Child obesity: BMI ≥ 95th centile of the UK90 growth reference
© NOO 2012
© NOO 2012
10
Child obesity: BMI ≥ 95th centile of the UK90 growth reference
Levels of obesity at 16 – 17 years
Measuring levels of obesity in
first and subsequent pregnancies
Smoking in pregnancy
Strongly correlated with
•Deprivation
•Teenage mothers
Best in country – 3.1%
Worst in country – 32.7%
Measuring smoking quit rates
during pregnancy and
establishing
which interventions work
Breastfeeding
Percentage breastfeeding
Breastfeeding initiation
versus deprivation
80
70
60
50
40
30
20
10
0
Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011
Initiation
Breastfeeding initiation,
younger mothers
Total at 6-8 weeks
Breastfeeding continuation,
older mothers
Breastfeeding at 3-4 months
Nutrition and vitamin D deficiency
Postnatal care
Hospital attendance rates aged under seven days in England,
rate per 1,000 live births (excludes birth)
35
30
Newborn babies (well babies)
coming back into hospital system
more often, as outpatients and
as admissions
25
20
rate
15
10
5
0
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
Hospital admission rates per 1,000
live births, 7 - 14 days after birth
13
12
11
10
9
8
2005/06
2006/07
2007/08
Aged 7 - 9 days
2008/09
2009/10
Aged 10 - 13 days
2010/11
2010/11
An issue to track and
for further investigation
Early Years – policy backdrop
Healthy Child Programme: 0- 5 years, 2009
Healthy Child Programme: 5 – 19 years, 2009
Healthy Lives, Healthy People: our Strategy for Public Health, 2010
Independent Review on Poverty and Life Chances – Frank Field, 2010
Early Intervention: the next steps – Graham Allen, 2011
Health visitor implementation plan 2011-15: a call to action, February 2011
Fair Society, Healthy Lives: the Marmot Review, 2011
NHS Outcomes Framework, 2011
Public Health Outcomes Framework, 2012
PREview – it’s complicated
PREview: Investing in children’s
services for a fairer future
•Analysis of Millennium Cohort Study
•Outcomes aged 5 – health, learning &
• development and behaviour
•Associated factors available during
pregnancy and early infancy
•Forward looking, evidence based
population modelling
•Resources for professionals to use with
families and communities
How PREview
evidence can be
used to show where
resources should be
targeted NOW to
address inequalities
in outcomes in five
years time
This map shows
what the outcomes
will be for children
in five years time
Not home
owner
Age 1st birth
< 20 years
Housing difficulties
Not living together
Other language
Never employed
Cohabiting
Multiple birth
Morbid
obesity
Behaviour
Unhappy or
not bothered about
pregnancy
No qualifications
Learning &
Development
First born
Deprivation
Smoking
Feeling low
(malaise)
Maternal general
health poor
Living in
poverty
3 or more
children in home
Health
Underweight
Powerlessness
(low self efficacy)
Late antenatal
care (after 20 wks)
Low income
Strength of associations between maternal factors, age 9 months, and child outcomes, age 5 years.
Maternal depression – persistent or episodic
Health
Areas where children are likely to have very good outcomes
Areas where children are likely to have good outcomes
Areas where children need additional preventive interventions to achieve
good outcomes
Areas where children need extra additional preventive interventions to
achieve good outcomes
Areas where children need intensive preventive interventions to achieve
good outcomes
Behaviour
Learning & Development
Child Age 9 months
Child Age 3 years
Outcome Age 5 years
√
X
Maternal
depression
X
√
Maternal
depression
√
√
Maternal
depression
Early Years - issues
•Most prevalent risk factors (from the Millennium Cohort Study)
Type of risk
Variable
% of
families
Depression
Either mother or father often feels depressed
19.4
Physical disability
Either mother or father has a longstanding
illness that limits daily activities
15.0
Alcohol
At least one of the parents is at risk of
alcoholism (> 14 units women, > 21 units men)
12.3
Substance misuse
Mother smoked during pregnancy
11.7
Teenage parenthood
Mother was < 20 years for their firstborn child
11.1
•Forum discussions
oMaternal mental health – previous history recorded during
pregnancy
oMaternal mental health – postnatal depression
oMaternal self efficacy
oParent /child relationships
oChild wellbeing
Early Years - outcomes
Child
Development
Outcome,
aged 2 – 21/2
years
School
attendance,
aged 5 to 18
years
School
readiness,
aged 5
years
The earlier the investment or intervention
the greater the Return on Investment
Self reported
health
behaviours
Not in
Education,
Employment or
Training, aged
16 to 18 years
Educational
attainment,
aged 11 to 18
years
Self reported
wellbeing
First time
entrants to
youth justice
system,
aged 10 to
17 years
Child Development Outcome,
aged 2-21/2 years
•Aim
oScreening tool to identify additional needs at individual level
oResults can be used to track improvements at a population
level, monitor via Public Health Outcomes Framework
•Use of Healthy Child Programme 2 – 21/2 year review
oCommissioning arrangements variable
oCoverage variable – average 70 %
oAge targeting and minority targeting variable
•Use of approved assessment tools
oSome good practice in place
oToo many home grown tools in use
oFavourites in use and in planning
oAges and Stages Questionnaire – ASQ
oParents Evaluation of Developmental Status – PEDS
•Implementation
oWith expanded Health Visitor workforce
oWith maternity and child health secondary uses dataset
The new system
Risks
Potential Solutions
Fragmented commissioning
High level service specifications
Commissioning Outcomes Framework
Keeping focus on children and young
people
A lead for CYP in all new
organisations at both national and
local level
Building in the Children’s voice
In authorisation specifications
Multiple agencies involved
Determinants of health very wide
ranging
National level – cabinet sub-committee
on public health
Local level – Health & Wellbeing
Board to bind all together
Urgent and primary care
GPs trained in paediatrics
Some recommendations
•Linking across sectors – health, education, social care
oBetter sharing of information
oUse of unique identifiers
•Child Health Information Systems
oResponsibility placed with NHS Commissioning Board
oClinical specification approved and published
•Electronic child health records - technology
oAccessible by professionals, patients, parents and carers
oUse in real time
oEnabled by mobile technology
•Child Health Records - content
oContains mothers background information, medical history and
orecord of unborn baby
oContains care plans for all children with disability, long term or
ocomplex conditions
•Information for the patients and public
oSingle source, approved, evidence based
For more information
www.chimat.org.uk
[email protected]
Contact your
ChiMat Local Specialist
http://www.chimat.org.uk/default.aspx?QN=CHIMAT_LOCAL