improving the health outcomes of children and young people · uk social return on investment...

Improving the Health Outcomes of

Children and Young People

Kate Thurland, Public Health England

17 March 2016

The current picture

Prevalence of excess weight among childrenNational Child Measurement Programme 2014/15

3

Child overweight (including obesity)/ excess weight: BMI ≥ 85th centile of the UK90 growth reference

One in five children in Reception is overweight or obese (boys 22.6%, girls 21.2%)

One in three children in Year 6 is overweight or obese (boys 34.9%, girls 31.5%)

Protecting and improving the nation’s health

4Child excess weight: BMI ≥ 85th centile of the UK90 growth reference

95% confidence intervals are displayed on the chart

Prevalence of excess weight by age and sex National Child Measurement Programme 2006/07 to 2014/15

24

.3%

21

.5%

33

.2%

30

.0%

24

.0%

21

.1%

34

.3%

30

.7%

24

.0%

21

.5%

34

.5%

30

.7%

24

.3%

21

.8%

35

.0%

31

.6%

23

.9%

21

.3%

34

.9%

31

.8%

23

.5%

21

.6%

35

.4%

32

.4%

23

.2%

21

.2%

34

.8%

31

.8%

23

.4%

21

.6%

35

.2%

31

.7%

22

.6%

21

.2%

34

.9%

31

.5%

Reception boys Reception girls Year 6 boys Year 6 girls

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15


Obesity prevalence by deprivation decileNational Child Measurement Programme 2014/15

5

Child obesity: BMI ≥ 95th centile of the UK90 growth reference

25.0%24.2%

22.7%21.2%

19.3%17.8%

16.0%15.0%

13.7%

11.5%12.0%11.2%

10.3% 9.7%9.0%

8.3% 7.6% 7.0% 6.8%5.7%

0%

5%

10%

15%

20%

25%

30%

Mostdeprived

Leastdeprived

Ob

esit

y p

reva

len

ce

Index of Multiple Deprivation 2010 decile

Year 6

Reception


Children with experience of

dental decay

6 Protecting and improving the nation’s health

3 year olds, 2013, 11.7

5 year olds, 2011/12, 27.9

12 year olds, 2008/09, 33.4

0

5

10

15

20

25

30

35

40

%

Correlation between proportion of three-year-old

children with caries experience and IMD 2010

score. Lower-tier local authorities in England, 2013


Association between decay and deprivation

(19% of the differences in prevalence and 25% of

the differences in severity explained by deprivation).

School readiness: Percentage of children

achieving a good level of development at

the end of reception (age 5 years) DfEvia PHOF

66.3% in 2014/15.

Ranging from

50.7% to 77.5%

8

FSP DIMENSIONS

• Personal

• Social

• Emotional

• Physical

• Communication

• Language

• Maths

• Literacy


Inequalities in school readiness:

Proportions achieving a good level of development DfE


England average

0 10 20 30 40 50 60 70 80 90 100

Statement or EHCP

SEN

Gypsy/Roma

Free school meals

Boys

Girls

Evidence

Focus on communication skills

• At 5 years 7% have speech, language and communication needs (Bercow, J. (2008), pg 13)

• Known social gradient, higher risks associated with free school

meals, benefits and area deprivation (Strand S. and Lindsay G.,2012, pg 28)

• The child’s communication environment (including number of books

available, trips to the library, parents teaching a range of activities

and the number of toys available) is the most important predictor of

language development at age 2 years. (Roulstone, S. Law, J., Rush, R., Clegg, J. and Peters T., (2011),

p 3 and pp 33-34.

• Vocabulary difficulties at age 5 are significantly associated with poor

literacy, mental health and employment outcomes at age 34. (Law, J., Rush,

R., Schoon, I. and Parsons, S. (2009). )

• 60% of young offenders have speech, language and communication

problems. (Professor Karen Bryan, Head of the School of Health and Social Care, University of Surrey)

APPG report on Speech and Language Difficulties, February 2013


12

Inequality in early cognitive development of children in the 1970 British Cohort

Study, at ages 22 months to 10 years

Environment matters for short,

medium and long term outcomes


13

Environment matters for short,

medium and long term outcomesBlackburn with Darwen Adverse Childhood Experiences:

Increased risk of having health behaviours/conditions in adulthood for individuals

who experienced four or more ACE

• STIs: risk is increased 30-fold

• Heroin or Crack user: risk is increased 10-fold

• Prison or cells: risk is increased 9-fold

• Hit someone last 12 months: risk is increased 8-fold

• Morbidly Obese : risk is increased 7-fold

• Been hit in last 12 month: risk is increased 5-fold

• Pregnant or got someone accidently pregnant under 18: risk is increased 4-fold

• Regular heavy drinker: risk is increased 4-fold

• Liver or digestive disease: risk is increased 2-foldAdverse childhood experience;retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Bellis M,Lowey H, Leckenby N, Hughes K, Harrison D Journal of PH, advance access 013/04/14


The case for a shift to prevention

– invest in early years to yield future returns

Avoid the human and economic costs associated with adverse childhood and

adult life experiences. Key adverse health outcomes would be reduced by 18–59%

if all children were as healthy as the most socially advantaged

Shift to prevention in child health profound impact on children’s lives and save

money in both long and short term

Estimated costs of dealing with a range of health and social problems:

Per hospital admission - inpatient CAMHS £24,482

Per week - Youth unemployment £133m

Per year - Youth crime £1.2billion, children in residential home £149,240, in

foster care £35,152

Educational underachievement £22 billion per generation

Annual Report of the Chief Medical Officer 2012. Our Children Deserve Better: Prevention Pays. Department of Health, 2013

UK Social Return on Investment studies showed returns of between £1.37 and £9.20

for every £1 invested in early years. WAVE Trust and DfE. Conception to Age two. The Age of Opportunity.


15

The Scientific Base

Protective factors

• Breast feeding and nutrition

Bernardo LH, Rajiv B, Jose Cm, Cesar GV (2007) Evidence on the long-term effects of breastfeeding. Systematic

reviews and meta-analysis, Geneva, WHO

• Immunisation

NICE (2009) reducing the differences in the uptake of immunizations (including targeted vaccines) among children and

young people under 19 , NICE PH guidance 21 London : NICE

• Parenting and parent–child relationship

Gardner FEM (1987) Positive interaction between mothers and children with conduct problems: is there training for

harmony as well as fighting? Journal of Abnormal Child 15, 283- 93 Psychology

• Relationship between parents

Coleman L, Glenn F (2009) When couples part, Understanding the consequences for adults and children London: One

plus One


Opportunities

17

Opportunities for LAs with transfer

commissioning 0-5 years: Healthy Child

Programme

• Joining up commissioning in local authorities for children’s public health,

early years and wider family services

• Involving HWB to promote aligned/joint commissioning between LA, CCGs

(which commission NHS children services) for services around the child and

family

• Streamlining universal access to Healthy Child Programme with early

intervention and targeted interventions/programmes for families needing

more help

• Joining up 0 – 5 Healthy Child Programme with 5 – 19 Healthy Child

Programme (which is already commissioned by LAs)

• Better integration of services at point of delivery with improved access and

experience

Improved outcomes for children families and communities and

reduced inequalities


Legislation and challenges

Legislative framework and

policy context

• Health and Social Care Act 2012

• NHS Mandate, Section 7A – national commissioning for Public Health

(healthcare delivered)

• Service specifications 1-> 14 - immunisations

• Service Specification 15 –> 26 - screening

• Service specification 27 – Children’s Public Health 0-5 years

• Service specification 28 – Child Health Information Systems

• Service specification 29,30 – prison health & sexual assault services

• Health Visiting Service Specification

• Family Nurse Partnership Service Specification


Healthy Child Programme/Children’s Public Health, 0-5 years

Maternal

antenatal

screening

Newborn

screening -

-Physical

-Hearing

-Blood spot

Infant medical

exam and

management

(6-8 weeks)

-Physical

exam

Pre-school immunisations

CCGs – from maternity &

paediatric services

NHS England

– from GPs

NHS England – from GPs

Antenatal

review

New baby

visit - 10

days

Infant

assessment

(6-8 weeks)

-Nutrition,

breastfeeding

& growth

Development

review 2-21/2years

1 year

assessment

Delivered by Health Visiting Teams and support staff

Child Health Information System (CHIS)

Via maternity systems Via primary care (GP) information systemsMaternity and

Children’s

Dataset (MCDS)

Reporting

Reporting

NH

S C

om

mis

sio

ner

LA

Co

mm

issio

ner

NHS England

Maternity and children’s dataset

– broad scopeSection Current scope Future roadmap

Maternity Background, previous

pregnancies, care, antenatal &

new-born screening, delivery

and outcome

Payment by results

Children Background, child protection,

infant screening (6-8 weeks),

immunisation, height & weight,

care events

Development reviews, child

development outcome aged 2

– 21/2 years

paediatric neurodisability,

community paediatrics & SEN

Mental Health Services Data

Set (includes children &

young people)

Referrals, care events,

outcomes

Improving Access to

Psychological Therapies

Linkage & reporting Mother to child, child to child,

pseudonymisation, user

friendly graphical front end

reporting


Service and impact

Mandated elements of service

• Antenatal health promoting visits

• New baby review

• 6-8 week assessment

• 1 year assessment

• 2 to 21/2 year review

High impact areas

• Transition to parenthood and the

early weeks

• Maternal (perinatal) mental health

• Breastfeeding

• Healthy weight (healthy diet and

being active)

• Managing minor illnesses and

reducing accidents

• Health, wellbeing & development

at 2 years & support to be ready

for school


Outcomes to date:

high impact areas High

impact

area

Key performance

indicators

Current

performance

Change

since

2010

Transition to

parenthood

and the early

weeks

Teenage pregnancy rates 22.8 per 1,000

15-17 year olds

(2014)

Improving

Smoking in pregnancy 11.4 % (2014/15) Improving

Low birth weight of term babies 2.9 % (2014) Stable

Infant mortality 4.0 per 1,000 live

births (2012-14)

Improving

Maternal

(perinatal)

mental health

Maternal mental health Metric in

development

Breastfeeding Breastfeeding at 6- 8 weeks 43.8 % (2014/15) Deteriorating

Healthy weight Excess weight at 4-5 years 21.9 % (2014/15) Improving

High

impact

area

Key performance

indicators

Current

performance

Change

since

2010

Managing

minor

illnesses &

reducing

accidents

A&E attendance rates, under 5

years

540.5 per 1,000

(2014/15)

Deteriorating

Emergency hospital admissions,

under 5 years

147.0 per 1,000

(2014/15)

Improving

Hospital admissions for injuries,

under 5 years

137.5 per 10,000

(2014/15)

Improving

Health,

wellbeing and

development

Tooth decay at 5 years, average

number of decayed teeth

0.9 per child

(2011/12)

Too early to

say

MMR immunisation coverage at 5

years

88.6 % (2014/15) Improving

Development outcomes at 2- 21/2years

Metric in

development

School readiness, good level of

development at end of reception

66.3 % (2014/15) Too early to

say

Outcomes to date:

high impact areas


Child Health Profiles

For further informationwww.gov.uk/phe

www.chimat.org.uk

[email protected]

Twitter@PHE_uk

Twitter@PHE_children

[email protected]


http://www.gov.uk/phe

http://www.chimat.org.uk/

mailto:[email protected]

mailto:[email protected]

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