Children and Young PeopleHealth 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 long-term 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 opportunityHow 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 2013Also 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 dietAdequate infant nutrition, particular benefit of breastfeedingGood hygiene, home safety and immunisationEarlier identification of need and provision of appropriate supportIntervene early to promote infant mental healthFull delivery of Healthy Child Programme with focus on promoting social and emotional developmentTargeted work in Children’s CentresQuality 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

GM Early Years New Delivery ModelWork is underway to develop:-

1. Single outcomes framework2. 8 Stage Assessment – standardised assessments used at key stages

from pregnancy to school, identifying needs and measuring progress3. Evidenced based interventions – delivered routinely and at scale4. Good use of Daycare, notably targeted two’s offer, with an

education, work and skills ‘contract’ for parents 5. Well equipped workforce from maternity to schools6. Data systems that support practice and track impact7. Long term evaluation

Ref Early Years Business Case Oct 2012

• 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 fiveoffer

5 to 19 yearsoffer

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 and

families (less CiN, less CPPs, less LAC)• Also: breastfeeding , smoking in pregnancy, immunisations & screening, smoking by YP, improved

mental health YP, Outcomes for LAC

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.

Children and Young People’s outcomes

Pre-birth

MEASURE GM AVERAGE

ENGLAND AVERAGE

#Conceptions (per 1,000 under 18yr olds: 2011) 37.8 30.7

*Infant deaths (per 100 live births carried to term: 2009-2011)

4.8 4.4

^Mothers smoking at time of birth (per 100 births: 2012/13)

15.6 12.6

Sources: # ONS Conception statistics:* www.phoutcomes.info: ^ www.hscic.gov.uk

Wider determinants

MEASURE GM AVERAGE

ENGLAND AVERAGE

~Lone parent households (% of population: 2011)

14.0 11.7

$Children living in poverty (% of population: 2010)

23.9 21.1

MEASURE GM ENGLANDTotal

&Domestic violence (number of recorded incidents: 2011/12)

47,496(6% of England

total)

745,105

Sources: ~ONS 2011 Census: $ ChiMat: &ONS Crime Statistics

Outcomes

MEASURE GM AVERAGE

ENGLAND AVERAGE

*School ready (% of population: 2011/12) 61.3 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+Deliberate and unintentional injuries under 18yr olds (per 10,000 <18yr olds: 2010/11)

147.9 124.3

Sources: * www.phoutcomes.info: + www.apho.org.uk

Levels of need

High need Low Numbers

Low need High Numbers

69,000

36%

3.6%

0.48%

0.29%CPP

LAC

CiN

Vulnerable

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.

• 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 follow-

up for higher risk cases• Only 5 repeat attendances within first year

Stockport A&E Pathway for Under 18’s

Trafford case study• 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?