HerefordshireA great place to grow up

@HfdsCouncil

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www.herefordshire.gov.uk

Foreword by Councillor Graham Powell, Cabinet Member Adults and Wellbeing

The responsibilityfor public healthtransferred from theNHS to localauthorities in April2013 and broughtwith it arequirement to issuean annual reportfrom the Director ofPublic Health. I’mpleased to introduce this, the third annualreport prepared by the Herefordshire publichealth team, which has as its focus one of theHerefordshire Health and Wellbeing Board‘skey themes – giving our children the bestpossible start in life.

The Health and Wellbeing Board has anoverarching vision that:

“Herefordshire residents are resilient; leadfulfilling lives; are emotionally and physically healthy and feel safe and secure”.

In order to achieve that vision it is critical thatwe work together to give children and youngpeople the best possible start in life and to putin place the building blocks that will lead themtowards a safe and healthy lifestyle.

Herefordshire is a wonderful place for ourchildren to grow up but there are significantdifferences in health and achievement as welook across the county. This is why I welcomedthe publication in January of the Children’sIntegrated Needs Assessment, which will bringfocus onto the provision of services that meetthe real needs of our children and youngpeople.The health and social care system acrossHerefordshire will face many challenges overthe next few years including reductions infunding and an increasing demand on servicesthrough population growth and ageing. TheHealth and Wellbeing strategy is beingrefreshed to recognise these challenges and toensure that as commissioners, service providersand residents we work together to improvethe health of the residents of Herefordshire.

I welcome this year’s report from the Directorof Public Health and in particular the focus onchildren and young people.

Councillor Graham PowellCabinet Member, Adults and WellbeingChair of Herefordshire Health andWellbeing Board

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Introduction by Councillor Jeremy Millar, Cabinet Member Children and Young People

I welcome thisreport and its focuson 0-5 year oldsboth as CabinetMember forChildren and YoungPeople’s Wellbeingand on behalf ofHerefordshire’sChildren and YoungPeople’s Partnership.

Our vision in Herefordshire is that children andyoung people are raised with their health andwellbeing needs met, that they are kept safefrom harm, and that they have theopportunities to make the most of theircapabilities. Working together in partnershipacross the county to ensure that children getthe best possible start in life is a fundamentallyimportant part of how we will achieve this.

This report supports the priorities of theChildren and Young People’s Partnershipwhich are to improve outcomes for ouryoungest children aged 0-5 years, improveoutcomes for children with a disability, developa “think family” approach and culture across

the partnership to target resources andsupport vulnerable families, improve theemotional and mental health and wellbeing ofchildren, young people and their parents andcarers, and reduce the number of youngpeople offending.

This year’s report reinforces the central role offamilies in shaping children’s health, wellbeingand development. In addition to reporting onwork that is in progress and planned, itprovides suggestions for how families can helpthemselves to support their children in theearly years and links to sources of furtherinformation. It also challenges us as acommunity to think about how we can “thinkfamily” and support all of our children to getoff to a great start in life.

I hope that you will enjoy reading this year’sDirector of Public Health annual report.

Councillor Jeremy MillarCabinet Member, Children and YoungPeopleChair of Herefordshire Children and YoungPeople's Partnership Board

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Acknowledgments: With contributions from the Herefordshire Public Health Department: Rod Thomson, Alison Merry, Susan Lloyd,Sophie Young and Latha UnnyDesigned by Herefordshire Council Design Team: Nick Winwood and Alun Herbert With thanks to Jo Davidson, Councillor Graham Powell, Councillor Jeremy Millar, Helen Coombes, Arif Mahmood,Kristan Pritchard, Jean Masanyero-Bennie, Andy Hough, Gwen Ellison and Helun Sandifort

Introduction by theDirector of Public Health

The starting pointfor Herefordshire’sHealth andWellbeing Strategyis the earlychildhood years andthe importance ofsupportivecommunities andfamilies. Inrecognising Herefordshire Council'scommitment to the health and wellbeing ofchildren and young people, my report this yearis concentrating on how we can improve thehealth and wellbeing of our very youngestchildren.

From birth to 5 years old children growmore than they will at any other time oftheir lives. Giving a child the best start in lifereally does set them up for the future.Whilst most families are successful insupporting and caring for themselves andtheir children, families sometimes benefitfrom extra support to help children toachieve their full potential. In this reportyou will read how we are working withfamilies, communities, service providers andthe NHS across Herefordshire to ensure thatfamilies are able to care for themselves andso that children get the best possible start inlife.

Professor Rod Thomson, Director ofPublic Health (Interim), HerefordshireCouncil

www.herefordshire.gov.uk4

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Herefordshire: A great place to

Starting school is a big life event and wewant all our children to be ready for that bigday. This means that the first five years of achild’s life are vitally important and we knowthat supporting our children to live in a homein which their health and wellbeing needsare met, where they are kept safe from harm,and where they are encouraged to maximisetheir capabilities is the key to having healthyand happy children in Herefordshire.

As a council we want to support children andfamilies and to do this we need a goodunderstanding about their lives and what theirneeds are. This year, with partners, we haveundertaken a detailed assessment of the needs ofchildren and young people in Herefordshire – theChildren’s Integrated Needs Assessment. This waspublished in January 2015 and is available to readon the council’s website (http://factsandfigures.herefordshire.gov.uk/CYP.aspx#Resource_box).

As a result we now have very good informationabout local children and families, their needs,what is going really well for children and youngpeople and what some of the local challenges are.

From this work, we have identified three particularpriorities for the future health and wellbeing ofchildren in the 0-5 age group:• achieving the best possible physical and mental

health and wellbeing,• ensuring that children are up-to-date with their

immunisations, and• keeping teeth healthy.

All these things will help to ensure that childrendevelop as well as they can in these early yearsand get off to a great start at school.

Starting well Breastfeeding gives babies a great start in lifeand we are encouraging breastfeeding bypromoting Start 4 Life, introducing the UNICEFbaby friendly initiative, providing informationabout the benefits of breastfeeding to mumsand dads, developing peer support by trainingmums to support others to breastfeed, andthrough the support that Health Visitors andChildren's Centres provide to parents.Information about the benefits of breastfeedingand on where to find support withbreastfeeding in Herefordshire can be found at:

http://www.nhs.uk/start4life/Pages/breastfeeding-benefits.aspxhttps://www.herefordshire.gov.uk/health-and-social-care/children-and-family-care/breastfeeding-supporthttp://www.wyevalley.nhs.uk/services/community-services/health-visiting.aspx

A balanced diet is important for everyone, butpregnant women, new mums and youngchildren may have additional needs and so maybenefit from vitamin supplements. During thepast year we have been working with thenational Healthy Start programme to set up aHealthy Start vitamin scheme in Herefordshirewhich provides vitamin supplements for youngchildren and pregnant women.

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o grow up

We are now working towards increasing thenumber of outlets where Healthy Start vitaminsare available. Parents can find moreinformation about the Healthy Start programmefrom their Health Visitor, local Children’s Centreor by visiting: http://www.healthystart.nhs.uk.

Many of the foods and drinks that children loveto eat contain surprisingly high levels of sugarand as a result children often have too muchsugar in their diet. This can lead to weight gainand an increased risk of developing diseasessuch as type 2 diabetes and heart disease inlater life. Sugar is also responsible for causingtooth decay. Taking care to limit the amount ofsugar that children consume is therefore a veryimportant part of healthy eating and swappingsugary food and drinks for healthier alternativesis a great way to improve children's health andto help keep teeth strong and healthy. Thereare lots of ideas for sugar swaps here: http://www.nhs.uk/Change4Life/Pages/low-sugar-healthy-snacks.aspx

This year we are also supporting the NHS Sportand Physical Activity Challenge within primaryschools.

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Dental HealthChildren in Herefordshire are more likely to havetooth decay at age three and age five thanchildren in other regions of England. In ourcounty around one in every five three year oldshas signs of tooth decay and this increases toone in every three five-year-old children. Wetend to see poorer dental health in areas of thecounty that are less economically advantaged.

We are working with Health Visitors andchildcare providers to improve the dental healthof young children in Herefordshire for exampleby promoting our “top tips for teeth”, byproviding dental packs to parents and by settingup supervised toothbrushing schemes.

Percentage of children obese or overweight:Percentage of children obese or overweight:

rece

pti

on

rece

pti

on

Herefordshire

England

19.3%

22.5%

(

year

6ye

ar 6

(Period: 2013/14 data)

Herefordshire

England

31.1%

33.5%

Recommended daily activitylevelsRecommended daily activitylevels

toddlers180 minutes

5-16 yearolds60 minutes

keeping activeKeeping active

To find out how children can become more activesearch change 4 Life or visit the NHS Choices website

Dental healthDental health

1 in 5 three year olds have tooth decay

1 in 3 five year olds have tooth decay

Age

3Age

5

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Our top tips for teeth:• Start brushing your child's teeth as soon as the first tooth comes through• Brush your child's teeth twice a day with a family fluoride toothpaste containing at least

1,000ppm fluoride (most toothpastes have 1,000ppm – 1,450ppm fluoride. Toothpastes withless than 1,000ppm fluoride are less effective at preventing decay)

• Make “last thing at night before bed” one of the times when you brush • Children up to 3 years of age should only use a smear of toothpaste (see below)• Children aged 3-6 years should use no more than a pea sized blob of toothpaste (see below)• After brushing, encourage your child to “spit out and not rinse”• Children need to be helped to brush and supervised by an adult whilst brushing until they are at

least 7 years old• Don't let your child eat or lick toothpaste from the tube.

• Take children to see the dentist regularly• Start taking your child to the dentist as soon as

the first tooth comes through• REMEMBER - NHS dental care is FREE for children

and for pregnant women and for new mums (up to 12 months after birth)

Smear - under 3 years Pea sized blob - 3 years +

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The NHS provides a programme of routinevaccinations to all children in order to protectthem against preventable infectious diseases.Vaccinations work on two important levels.Firstly they offer protection to the individual childwho receives the vaccination, and secondly theyprotect the wider community by reducing theability of an infection to spread, but only when95 or more out of every 100 children have beenvaccinated (this is called 'herd immunity'). InHerefordshire the percentage of children who areup-to-date with their routine vaccinations islower than the 95% required to provide the bestpossible protection for everyone and we areworking with the NHS to increase the numbersof local children who are immunised. Up to theage of one year, the majority of children inHerefordshire are immunised with approximately94 in every 100 children receiving theirvaccinations. However, at two years of age the

uptake of routine vaccinations for Meningitis C(MenC), Haemophilus influenza type B (Hib) andPneumococcal vaccine booster (PCV) is lowerthan the England average. Unvaccinatedchildren are at potential risk of catching thesediseases each of which can lead to serious illnessand potentially can be fatal.

Make sure your child is protected by taking themalong for their routine vaccinations at therecommended time.

You can find out more about routine childhoodvaccinations from your Health Visitor, SchoolNurse or GP practice or by visiting:http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-schedule-age-checklist.aspx

Protecting our children from infectious diseases

Protecting our children againstpreventable infectious diseases• Herefordshire’s Healthy Child

Programme encourages parents to gettheir child immunised

• Our Health Visitors and School Nursesare talking to parents and carers aboutthe importance of childhoodimmunisations

• We make sure that medical centres havesystems to call children for theirimmunisations through our partner,NHS England.

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Education - early yearsfoundation stage profileEducation - early yearsfoundation stage profile

60%

Being ready for school A child who lives in a family and community inwhich their health and wellbeing needs aremet and where they are kept safe from harm islikely to maximise his/her potential. It’simportant that before a child goes to school heor she has a basic understanding of speaking,listening and numbers, taking turns andsharing, that they are able to do everyday taskssuch as using a knife and fork to eat and thatthey are toilet trained. This underpins a child’seducation, which in turn underpins theiremotional wellbeing and their growth into astrong resilient adult.

We are training staff who work with pre-school children to help children to developtheir speaking and listening skills and to usephonics to support the development ofreading skills.We deliver accredited parenting programmesin groups and on a one to one basis inchildren’s centres, together with familylearning programmes, including work relatedskills.We support providers of early years’ services toensure that the transition to reception is assmooth as possible for the child and theirfamily.

What are we doing to help childrendevelop their speaking, listening andnumbers skills?We have expanded the number of places for 2year olds entitled to free education.We are promoting a campaign to encouragenursery rhymes and reading with children,including annual reading challenges andimproved access to neighbourhood libraries.Our 10 children's centres are supportingparenting and coordinating support services inspecific areas of the county.

What can parents do to help youngchildren to develop their readiness forschool?Parents and families are children’s firstteachers and are the most important peoplewhen it comes to helping young children todevelop the skills they will need when theystart school. Here are some of the things thatparents of pre-school children can do todevelop their child’s readiness for school:• Playing with your child and encouraging

them to play with other children helps todevelop a wide range of skills includingspeaking and listening, sharing and takingturns, developing confidence and makingfriends

• Singing nursery rhymes and children’s songshelps to develop speaking, listening andsimple maths skills

• Introducing your child to books and storiesfrom an early age will help to lay thefoundations for reading and writing

• Attending nursery, play-group or other earlyyears’ provision helps children to developmany of the skills they will need to get offto a great start at school.

All three year olds and four year olds areentitled to 570 hours of free childcare per yearand now some two year olds are also eligiblefor this. More information on childcare inHerefordshire is available at:https://www.herefordshire.gov.uk/education-and-learning/early-years-and-childcare/childcare

In 2013/14, 60 out of every 100 Herefordshirechildren had achieved a ‘good level ofdevelopment’. This is better than the numbersfor the West Midlands (58) and the same asthe England average in the same period.However it still means that 4 in 10 children arenot achieving a good level of development,hence the importance of helping children andtheir families.

60% of Herefordshire pupils achieved a good level of

development at reception age 4-5 years old

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Children and young people with poor mentalhealth are more likely to have poor educationalattainment and employment prospects, socialrelationship difficulties, physical ill health andsubstance misuse problems and to becomeinvolved in offending. We also know from the2014 Chief Medical Officer’s report thatchildren and young people from the pooresthouseholds are three times more likely to havea mental health problem than those growingup in better-off homes.

Supporting parents during pregnancy and theearly years is known to impact positively onthe mental health of children and youngpeople and a secure parent/child relationshipcontributes to a positive attachment and helpsto create emotional resilience in children.

There are five simple steps that everyone canuse to improve their mental wellbeing –“connect”, “be active”, “keep learning”,“give” and “take notice”. We are usingthese “Five Ways to Wellbeing” in ourapproach to improving mental wellbeing inchildren.

We are keen to support the mental wellbeingof local children and young people and theirfamilies and the Children and Young People’sPartnership has developed a multi-agencystrategy to support emotional wellbeing andmental health for children, young people andtheir families. We want children, youngpeople and their families to:

• Be aware of their own emotionalwellbeing and mental health, and thatof others

• Develop good emotional wellbeingand mental health

• Be able to get further support, adviceand access to more specialisedassistance when they need it.

Mental health and wellbeing in children and young people

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http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/improve-men-tal-wellbeing.aspx#Evidence

The Five Steps to Wellbeing:1) ConnectThere is strong evidence to show that feelingclose to and valued by other people is afundamental human need and contributes tofunctioning well. Social relationships areimportant for promoting wellbeing and can actas a buffer against mental ill health for people ofall ages.

2) Be activeRegular physical activity promotes wellbeingand is associated with lower rates of depressionand anxiety across all age groups. The activitydoesn’t need to be particularly intense to makea difference. For example walking providessome level of exercise and has the benefit ofencouraging social interactions.

3) Keep learningContinued learning through life enhances self-esteem and encourages social interaction and amore active life.

4) GiveGiving to others can improve mental wellbeingfrom small acts, such as a smile, thank you orkind word, through to larger acts, such asvolunteering which can improve mentalwellbeing and build social networks. Researchinto actions for promoting happiness hasshown that committing an act of kindnessonce a week over a six-week period isassociated with an increase in wellbeing.

5) Take noticeTaking notice, being aware of what ishappening and “savoring the moment” canhelp to reaffirm life priorities, enhance self-understanding and can help people to makepositive choices based on their own values andmotivations. This is sometimes called"mindfulness", and it can positively change theway you feel about life and how you approachchallenges.

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We provide extra support for Herefordshire families and

children who are vulnerable

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• We provide facilities/amenities for disabledchildren within their homes.

• We act early where children are at risk ofhomelessness.

• We work in partnership with a number oforganisations such as West MerciaWomen’s Aid which provides outreachservices to support children and youngpeople affected by domestic abuse.

• We provide benefits and debt advice to parentsin difficulty who need support.

• We have a dedicated team and service whichworks with looked after children.

For more information visit: Children with disabilities and special needs:www.herefordshire.gov.uk/health-and-social-care/children-and-family-care/disabilities-and-special-needs?q=disabledchildren&type=suggestedpage

Homelessness:www.herefordshire.gov.uk/housing/homelessness-and-prevention/homelessness-advice-and-support

Domestic abuse:www.westmerciawomensaid.org

The Healthy Child Programme

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In Herefordshire we support the aims of theHealthy Child Programme which include:• helping parents to develop a strong bond

with their child • encouraging breastfeeding• encouraging children to stay healthy and

safe• reducing obesity in children by promoting

healthy eating and physical activity• identifying problems as early as possible so

that any necessary help can be put in placeat the earliest opportunity – for exampleproblems with health and developmentsuch as learning difficulties or with a child’ssafety such as parental neglect

• protecting children from serious diseases,through screening and immunisation

• ensuring that children are prepared forschool

• identifying and helping children withproblems that might affect their chanceslater in life.

Health Visiting and School Nursing services arepart of the Healthy Child Programme andprovide support to children aged 0-5 (HealthVisiting) and 5-19 (School Nursing) and to theirfamilies and carers.

Herefordshire Council took on commissioningresponsibility for School Nursing in 2013 andsince then we have worked closely with thelocal School Nurses to review, redesign andimprove the services they offer to 5-19 yearolds. In October 2015 the Council willbecome responsible for commissioning theHealth Visiting service and we are alreadyworking with the Health Visitors to prepare forthis transfer and to ensure that services for 0-5and 5-19 year olds work efficiently togetherand are integrated with other services forchildren, young people and families.

You can find out more about the Healthy ChildProgramme and about Health Visitors andSchool Nurses in Herefordshire at the followingwebsites:

https://www.gov.uk/government/policies/giving-all-children-a-healthy-start-in-lifehttp://www.wyevalley.nhs.uk/services/community-services/health-visiting.aspxhttp://www.wyevalley.nhs.uk/services/community-services/school-nursing.aspx

At the end of March 2014 Herefordshire’spublic health team celebrated its first full yearintegrated into Herefordshire Council.

The move to the Local Authority hasbroadened the way in which health is seen inHerefordshire. Health is no longer the preserveof the NHS and Herefordshire Council hasembraced its role particularly in preventing illhealth, promoting good health and protectingresidents from infectious disease. This hasbeen a major change and has enabled the corepublic health team to work across the councilin a way that has not happened previously,and to contribute to health in children’s andadults’ services including children’s centres,housing and in many other departments.

Later in this report we have written an updateon what we have delivered against therecommendations in last year’s Director ofPublic Health Annual Report. In addition, in2013/14 we also successfully set up theHerefordshire Health Protection Committee, amulti-agency group that assures that residentshave appropriate access to immunisation,screening and protection againstcommunicable diseases.

We ran a large number of health awarenesscampaigns across the county including HIVTesting week, Change 4 Life, Dry January,Sugar Swaps and many more.

Working with colleagues across health andsocial care has given us the opportunity tocontribute an evidence-base where we wouldnot have had the opportunity in the past,including producing the Children’s IntegratedNeeds Assessment which this report is basedon.

Progress since last year

Last year the Director of Public Health's Annualreport was on the topic of Collaborating forHealth in Herefordshire and in it, the Directorof Public Health made recommendationsabout:

1. Tackling health inequalities: a communitybased asset approach

2. Working together to reduce alcohol relatedharm

3. Public health and carers

We have chosen to change the format of thisyear’s report and you will findrecommendations for action this year in theChildren’s Integrated Needs Assessment.Below is an update on the public healthprogress against last year’s recommendations.

Public health in Herefordshire Council

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RECOMMENDATION PROGRESS

Tackling health inequalities: a community asset based approach

· To seek out opportunities for collaboration and worktogether on lifestyle behaviour change.

The Council’s Healthy Lifestyle Trainer Service supported awide range of healthy summer events including promoting Change4Life “Disney 10 minute shake up”,Wye Weight – group support programme for healthyweight, Walking for Health and Community Games(linked to the Olympic legacy).

· To gain a better understanding of our communitiesand work with them to reduce the social gradient inhealth.

A pilot programme of work is being delivered by SouthWye Regeneration Partnership to use community assets(people and community buildings) so that people getinvolved in making healthy lifestyle changes and tackleinequalities in health.

· To develop our understanding of people’s behaviours and influences on behaviour inHerefordshire, gaining insight through socialmarketing.

A number of social marketing campaigns have beenpromoted in Herefordshire including:Change4LifeNo Smoking DayStoptoberAlcohol Awareness WeekSexual Health Awareness Weekand our local campaigns “Change a Little, Save a Lot”.

· To review existing services and commission healthylifestyle behaviour change services such as for stopsmoking and weight management.

We are recommissioning the current behaviour changeservices, including NHS Health Checks, a mandatoryservice, and Stop Smoking support. These will be in placefor delivery in 2015/16.

Working together to reduce alcohol related harm

· That the Health and Wellbeing Board and partnerorganisations across Herefordshire continue to givepriority to reducing alcohol related harm and todeveloping our strategic intelligence about thecomplexities of alcohol harm in our community,focusing on identifying areas of overlap wherecombined efforts have the potential to make the most impact.

We are in the process of re-commissioning an evidencebased drug and alcohol service. The new service requirespartners across the health and social care system to workjointly and reduce alcohol related harm.

· That partner agencies commit to contributing theirdata and intelligence in order that we can build acomprehensive understanding of alcohol use and the consequences of alcohol misuse in Herefordshire.

Data continues to be shared at the Drug and AlcoholOperational Delivery Group (see below) providing apicture of alcohol related harm within the County.

· That partner agencies commit to a more coordinatedapproach to working together to address alcoholrelated harm so that resources can be targetedfollowing a strategic and evidence-based approach.

A new group, Drug and Alcohol Strategic Delivery Group,has been established to develop a drugs and alcoholstrategy for Herefordshire.

· That the Alcohol Harm Reduction Group provides aforum to bring together plans for tackling theinfluence of alcohol as it impacts on domestic violence and abuse, offender management andFamilies in Need.

The former Alcohol Harm Reduction Group has changedits terms of reference to include drugs, young people andpublic places in addition to its work on improving thenight time economy and sharing data on alcohol relatedharm. The group is now called the Drug and AlcoholOperational Delivery Group.

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RECOMMENDATION PROGRESS

Public Health and carers

· The needs of informal carers should be considered inthe scoping of the 2013/14 Herefordshire IntegratedNeeds Assessment.

Close working with Hereford Carers Support. Needs Assessment to be progressed in 2014/15

· Evidence of good practice should be reviewed forapproaches to best support effective and sustainableinformal care.

Close working with Hereford Carers Support. Evidence base to be included in needs assessment to beprogressed in 2014/15

· When allocating resources, health economicsprinciples should be applied to efficiently meet theneeds of informal carers and benefit the wider healthand social care system.

The Herefordshire Carers Strategy 2012-2015 recognisesthe contribution that carers make to the lives of theperson they are caring for and the wider society. Thepriorities within the strategy reflect the national prioritiesand the need to identify carers at the appropriate timeand to support them to have a life of their own.Herefordshire Carers Support provides an element of thisthrough the service they provide.

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We are working in partnership with families, service providers and NHS Community groups acrossHerefordshire so that each child has the opportunity to grow up healthy and happy. There are stillchallenges, but here are some of Herefordshire’s successes:

• Babies are less likely to be born with a low birth weight. • Babies are more likely to have been breastfed at birth, although the numbers being breastfed at

6-8 weeks are average.• Children generally are developmentally ready for school. • Herefordshire’s looked after children have better mental health than both the England average

for looked after children and the ‘norm’ for British children who are not looked after.• Children in reception and year six are less likely to be overweight or obese than children across

the West Midlands and England, although two of every ten of our children are overweight orobese by the time they are measured in reception class which is a real cause for concern.

• Herefordshire’s children have levels of immunisation coverage for Measles, Mumps and Rubellathat are the same as coverage across England.

• Looked after children have better rates of immunisation compared to children in the generalpopulation; (92% in 2012-2013; 96% for children who were looked after for 12 months).

You can find out more from these websites:

3 Comparisons are with the West Midlands and England norm.

Herefordshire: a great place to grow uperefordshire: a great place to grow up

What you can doWhat you can do

3

Start 4 Lifehttp://www.nhs.uk/start4life/Pages/healthy-pregnancy-baby-advice.aspx

Herefordshire Councilhttps://www.herefordshire.gov.uk/education-and-learning/early-years-and-childcare/supporting-parents-of-children-aged-0-4-years

Change for lifehttp://www.nhs.uk/change4life/Pages/change-for-life.aspx