1. Feedback to Salford from Teenage Pregnancy National Support Team 23 rd April 2008 Appendix A

2. To be covered today Themes of Teenage Pregnancy Overall Strengths The Scale of the Challenge Issues and Recommendations by Theme Priority Actions Summary of Support Offered Plenary Session Discussion NST Contact Details

3. Themes of Teenage Pregnancy Strategy Data and Needs Assessment Communication Implementation Contraception/Sexual Health Advice and Services Delivery of SRE/PSHCE Targeted work Workforce training Integrated services for young people Raising aspirations Work with parents and carers

4. Overall Strengths

5. Leadership, Partnership & Commitment There is strong senior level ownership and commitment for improving teenage pregnancy by the Leader of the Council, Elected Members, Chief Executives of the Primary Care Trust (PCT) and Local Authority (LA), Director of Children’s Services, Director of Public Health and other senior officers. The 2006-07 Scrutiny of Teenage Pregnancy has been an important catalyst for refocusing the strategy. The Star Chamber is driving the teenage pregnancy agenda forward. Teenage pregnancy is one of the priorities in the Local Area Agreement (LAA) and Children and Young People’s Plan (CYPP). Major regeneration and economic growth provides an opportunity to make a real impact on raising aspirations for the community of Salford.

6. Overall Strengths cont…. There are a number of joint appointments by the PCT and LA including Director of Children's Strategy and Commissioning and Director of Public Health. History of integrated structures and services and joint commissioning for adults between the LA and PCT. The PCT is a health improving organisation. The capacity for data analysis within the PCT is being strengthened. Strong commitment and enthusiasm by the Teenage Pregnancy Co-ordinator and Teenage Pregnancy Team. Excellent support for teenage parents.

7. Overall Strengths cont…. Raising Aspirations, SRE & Schools The percentage of young people who are Not in Education Employment or Training (NEET) has reduced by 40% from 12.1% in 2003 to 7.4% in 2007. Exclusion and attendance rates are ‘moving in the right direction’. 77.2% of young people in Salford progress into further learning on leaving school. Increasing numbers of young people progressing to higher education. Healthy Schools uptake is above national and regional targets. Number of pupils attaining 5 or more A*- C grades at GCSE has increased year on year since 2004 to 59.6% in 2007 and has increased at a faster rate than nationally over the last few years. Developing Healthy Colleges and Healthy Care standards. Good outcomes for Looked after Children.

8. Overall Strengths cont…. Raising Aspirations, SRE & Schools cont.. Salford is part of the North West pilot for the Sex and Relationship Education (SRE) spiral curriculum. A framework has been developed to audit standards of SRE within secondary schools and results are being used by School Improvement Officers and School Improvement Partners to develop action plans with schools. A “Primary PSHCE (Personal, Social, Health and Citizenship Education) Curriculum Planning Matrix” has been developed with a monitoring and auditing tool. Integrated approach to support delivery of drug, alcohol and SRE in schools which is also being targeted at parents. Commitment by Youth Service to delivering Sexual Health services evidenced by all Youth Workers trained in condom distribution and Chlamydia screening and under review to maintain delivery.

9. Scale of the Challenge

10. Salford Performance 1998 baseline 2010 target 1998 baseline 2010 target

11. Scale of the Challenge In 2006, Salford had an under-18 conception rate of 58.8 per 1000 females aged 15-17 - 45% higher than the England average of 40.4 per 1000. (Regional average 44 per 1000). Overall, between 1998 and 2006, Salford’s under-18 conception rate has remained relatively static with an overall reduction of 4.4% - compared to an overall decline of 12.5% for the North West region and a 13.3% reduction for England. Whilst the under-18 conception rate has remained relatively static in Salford, the proportion of conceptions leading to birth have reduced overall, whilst the abortion proportion has increased. A majority (60%) of wards in Salford are ‘hotspots’ with rates among the highest 20% in England.

12. Scale of the Challenge cont… Nearly three in four (73%) teenage mothers in Salford are lone parents, compared with 61% for England as a whole. In 2006, 15% of abortions under-19 in Salford were repeat abortions (i.e. followed one or more previous abortions). This proportion is higher than the national average of 11%. Proportion of conceptions for under 16 higher than the regional and national average (11.2% compared to 8.1% and 7.9%). Salford is the 15 th most deprived LA area in England. 28,935 people claiming out of work benefit – 20.7% of working age population (national average is 14.2%).

13. Scale of the Challenge cont… Smoking, obesity, alcohol, cardiovascular disease, cancer, mental heath and sexual health are public health priorities in Salford. 6,222 domestic abuse incidents were reported between 2006-2007. Educational attainment and young people in Education Employment or Training (EET) is still below the national average. Major reconfiguration of hospital services. High number of Looked After Children and school exclusions. No city centre focus for service delivery. Issues for young people around transport links and costs in Salford.

14. Scale of the Challenge cont… Raising aspirations is a huge challenge (with 36.14% of women having no qualifications and 33.43% of 16-24 year olds being unemployed). The perception in Salford that teenage pregnancy is inevitable and acceptable. Changing demographics and faith issues locally. Increasing diversity of local population. Reliance on projects to deliver the strategy. The perception that ‘life’s on hold’ for some young people’s services due to the need to align services with new funding streams.

15. Why does reducing teenage pregnancy matter? Teenage mothers compared to mothers giving birth aged 24 or over: Poor maternal and child health outcomes. Poor economic well being. The majority of teenage pregnancies are unplanned and nearly half end in abortion. Among the most vulnerable girls, the risk of becoming a teenage mother is nearly 1 in 3.

16. Why does reducing teenage pregnancy matter? Poor child health outcomes The infant mortality rate for babies born to teenage mothers is 60% higher. 25% higher risk of low birth weight. Affected by: Late booking for antenatal care (on average 16 weeks). 3 times more likely to smoke throughout their pregnancy. 50% less likely to breastfeed. Poor maternal nutrition.

17. Why does reducing teenage pregnancy matter? Poor emotional health and well being 3 times the rate of post-natal depression of older mothers. Higher rates of poor mental health for up to 3 years after the birth. Higher risk of partnership breakdown and isolation. More likely to live in poor quality housing. Affecting the well being of their children and contributing to: Higher accident rates - such as from falls and poisoning. More behavioural problems - conduct, emotional and hyperactivity problems.

18. Why does reducing teenage pregnancy matter? Poor economic well being Almost 40% of teenage mothers have no qualifications. 30% of young people are in Education, Employment or Training (EET) compared with 90% of all 16-19 year olds. 22% more likely to be living in poverty at 30. Much less likely to be employed or living with a partner. 20% more likely to have no qualifications at age 30. Young fathers twice as likely to be unemployed at age 30 – even after taking account of deprivation. Which also affects the economic well being of their children: Children of teenage mothers have a 63% increased risk of being born into poverty. Lower academic attainment. A higher risk of economic inactivity in later life.

19. The issue is complex as there are a range of factors that are associated with whether a teenager becomes pregnant

20. Educational attainment has an impact on conception rates over and above the effects of deprivation Deprived wards with higher educational attainment have lower teenage conception rates

21. … on sexual activity under 16 Source: NATSAL 2000 Girls having sex <16 are nearly three times more likely to become pregnant under 18 than those having sex at 16 or over

22. …and on non-use of contraception Source: NATSAL 2000

23. Issues and Recommendations

24. Strategy We would recommend further developing the Star Chamber to become a small executive group responsible for: - Identifying the long term vision - Driving the teenage pregnancy agenda strategically - Making commissioning decisions - Performance managing the Teenage Pregnancy strategy - Integrating teenage pregnancy prevention into the wider agenda. Membership of the executive group needs to include Chief Executives (CEs) of Local Authority (LA) and Primary Care Trust (PCT), Director of Children’s Services (DCS), Director of Public Health (DPH), Children’s Commissioner and Strategic Lead for Teenage Pregnancy.

25. Issues and Recommendations Strategy cont… There needs to be clarity about the relationship and functions between the Children and Young People’s Partnership Board, Star Chamber executive group, Teenage Pregnancy Partnership Board (TPPB) and any sub groups. There is a need to establish a clear vision for the prevention of teenage pregnancy in Salford. A visioning planning session with the Star Chamber would be beneficial. An outcome of this could be a shared set of principles in relation to the objectives of the strategy. - The NST can help facilitate this. We recommend that the Star Chamber review the teenage pregnancy action plan using the Outcomes Based Accountability (OBA) model to ensure it is SMARTER, outcomes focussed and has wider ownership. – RTPC and NST can provide support.

26. Issues and Recommendations Strategy cont… There is a need to review the role of the teenage pregnancy strategic lead within Children’s Services to ensure that they have the capacity and authority to lead, commission and performance manage the Teenage Pregnancy strategy and are accountable to the Star Chamber. - NST and RTPC can provide support and advice. We endorse the current review of the TPPB. This needs to be informed by the visioning event and ensure seniority of membership to add further decision makers such as Headteachers/Principals, Governors and School Improvement Officers. All members should prioritise their attendance. - NST can advise on roles and responsibilities. The role of the TPPB should be to implement the Teenage Pregnancy Strategy and inform commissioning decisions.

27. Issues and Recommendations Strategy cont… Following the visioning process, we recommend a briefing session for all elected members to ensure they are supported to champion teenage pregnancy issues. – RTPC and NST can help facilitate this. There is a need to ensure that all frontline universal and targeted services systematically deliver teenage pregnancy prevention e.g. by School Health Advisers, Health Visitors, youth services, Children’s Centres, Extended Services, including Community, Voluntary and Faith organisations. There is a need to strategically link work around young people's alcohol and teenage pregnancy under a broader risk taking umbrella. We recommend that you review teenage pregnancy specialist posts to consider roles within new locality working.

28. Issues and Recommendations Strategy cont… We recommend building upon and formally identifying senior strategic Teenage Pregnancy champions including at Chief Executive level, Directors, Elected Members, primary and secondary Head Teachers, College Principals, School Governing Bodies and GPs. – NST can provide advice and support. We recommend that you build upon the good examples of young people’s involvement in Salford to inform the development, review and implementation of the Teenage Pregnancy action plan.

30. Issues and Recommendations Data and Needs Assessment There is a need for an up-to-date local young people’s Sexual Health Needs Assessment to identify the most vulnerable groups and hotspot areas. This should feed into the commissioning process on an ongoing basis. We recommend using the NST Sexual Health Needs Assessment ‘How to’ Guide. – NST can provide examples and support. There is a need to systematically review local data collection systems and data sharing protocols, to facilitate the routine sharing of information between agencies and allow data sources to be combined for analysis and improved targeting, commissioning and performance management.

31. Issues and Recommendations Data and Needs Assessment cont… We recommend senior level intervention from the PCT and the Local Authority to ensure any existing barriers are removed, to allow data sharing and analysis. A local indicator set should be developed to monitor and performance manage delivery. Indicators should build on those included in the TPU (Teenage Pregnancy Unit) National Teenage Pregnancy Local Monitoring Data Set. – RTPC can support this work. We recommend a data specialist lead, working closely with the Strategic Teenage Pregnancy lead, takes forward work on teenage pregnancy data and analysis. We endorse the establishment of the Data Sub-group.

32. Issues and Recommendations Data and Needs Assessment cont… Analysis of local data should be used as a lever to engage and inform partners, including schools, colleges and School Improvements Partners (SIPs) and School Improvement Officers to develop their challenge and support roles. We welcome the innovative work already undertaken towards this. There is a need to prioritise the collection, analysis and sharing of conception and birth data for Looked After Children (LAC), Care Leavers and young people with physical and learning disabilities. – NST can provide further support. There is also a need to gather local intelligence from children, young people and professionals to provide an understanding of why teenage girls in Salford become pregnant. – NST can provide examples.

34. Issues and Recommendations Communication We recommend the development of a specific Teenage Pregnancy Communication Strategy and Action Plan to support the delivery of the local Teenage Pregnancy strategy, which needs to include internal and external communication, media handling protocols and young people’s service publicity. – RTPC and NST can provide examples and advice. Internal communication needs to be strengthened, with regular and systematic communications within and between the teenage pregnancy structures, the Children and Young People’s Partnership Board and those delivering services and interventions to children, young people and families. This needs to include face to face briefings for management and relevant partnership groups, as well as being included in newsletters and fact sheets.

35. Issues and Recommendations Communication cont… It is crucial to ensure that the Communication Strategy and Action Plan strongly promote the philosophy that prevention of teenage pregnancy needs to be everybody’s responsibility. The Teenage Pregnancy Communication Strategy and Plan also needs to challenge the perception that teenage pregnancy is acceptable and inevitable in some communities. Teenage pregnancy prevention needs to continue to be linked to raising aspirations. Clear and consistent messages need to be developed with, and targeted at, parents, carers and young people most at risk, for example Looked After Children, Care Leavers and those in BME and faith communities. – NST can provide support.

36. Issues and Recommendations Communication cont… Information about services needs to be developed by, and for, young people. This needs to be disseminated widely, in a range of formats, to young people, their parents/carers, and professionals. We support your plans to develop localised community based campaigns and information for young people and parents/carers. You might wish to consider social marketing approaches. – NST can advise. We would recommend using the national TPU communications CD ROM “RU thinking campaign toolkit” to help with communication of the local strategy and to plan and publicise the availability of national and local resources and services.

38. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services There needs to be clear Contraception and Sexual Health Joint Commissioning informed by a Sexual Health Needs Assessment and integrated into wider Children’s Commissioning. – RTPC and Greater Manchester Sexual Health Network can provide support with this. We endorse the work on developing service specifications for young people‘s sexual health services in all settings. There is also the need to develop Care Pathways to define the young person’s journey through the system and the contribution of all relevant professionals working with young people.

39. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services cont… The Contraception and Sexual Health Joint Commissioning needs to be developed in partnership, to include Integrated Youth Support Services (IYSS), Extended Services, Children’s Centres, Training Providers, Building Schools for the Future (BSF) and through the Youth Service Integrated Premises Strategy. There needs to be a range of sexual health services in a variety of young people’s settings, including outreach and domiciliary settings, available 7 days a week and in hotspot areas, for example through Extended Services, secondary sector settings, youth services, Children's Centres, community pharmacies, health visiting, midwifery and general practice, voluntary, community and faith settings, Youth Offending Service, Pupil Referral Units and Colleges. NST can provide examples.

40. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services cont… We recommend a review of existing condom provision. The review should be used to inform commissioning and the development of a comprehensive condom distribution strategy which is delivered in a wide range of young people’s settings including voluntary, community and faith organisations, residential homes and foster care provision. – NST can offer support. We recommend that you build capacity to deliver sexual health services through non-health staff and settings. For example, youth services providing condoms, Chlamydia screening, pregnancy testing, etc. There is a need to develop holistic school and college based health services including contraception and sexual health services.

41. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services cont… School Health Advisors should play an integral role in the delivery of sexual health services and Sex and Relationship Education (SRE) in line with national guidance. There is a need to review the capacity of School Health Advisors to fulfil this important role and ensure that they have received training and development opportunities to achieve this. It is important to ensure the involvement of young people in service development, design, review and implementation, e.g. mystery shopper schemes, patient panels. - NST can provide examples. All young people’s services need to be delivered and monitored to meet the Department of Health ‘You’re Welcome’ quality standards.

42. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services cont… We recommend a review of the service specification for abortion services to ensure this is consistent with the Greater Manchester Sexual Health Network service specification and includes feedback to referrers on contraception provided to ensure appropriate follow up. - RTPC and Greater Manchester Sexual Health Network can provide support. There is a need to review the Emergency Hormonal Contraception (EHC) pharmacy scheme to ensure it is promoted to young people and professionals, that it is within the targeted areas and groups, and is freely available. The scheme needs to link with the successful Chlamydia Screening Programme. Long Acting Reversible Contraception (LARC) should be more widely considered as a first line preventative method with consistent follow up. – NST can offer support.

43. Issues and Recommendations Implementation – Delivery of SRE/PSHCE We recognise that there is high level commitment to provide strong direction to schools about the importance of Sex and Relationships Education and Personal, Social, Health and Citizenship Education (PSHCE) and to promote proactive engagement of all schools. This process should be supported by work to develop champions. – NST can support with this. We would recommend identifying teenage pregnancy champions among the school governing bodies across the city e.g. through the LA Governor Lead, Primary and Secondary Head Teacher Fora. These champions could work with schools to identify and share good practice and ensure there is understanding of the relationship between the prevention of teenage pregnancy and educational attainment.

44. Issues and Recommendations Implementation – Delivery of SRE/PSHCE cont… We recommend a Salford-wide Sex and Relationships Education (SRE) approach incorporating policy, training and schemes of work, is further developed and implemented in all secondary schools and all agencies working with children and young people to ensure consistency and quality standards, for example across the 14-19 sector, Pupil Referral Units, colleges, youth services and social care settings. This should incorporate existing local and national guidance. - NST and RTPC can help with this. There is a need for Salford to explicitly cover issues of alcohol and risky behaviour in conjunction with SRE.

45. Issues and Recommendations Implementation – Delivery of SRE/PSHCE cont… School Improvement Partners (SIPs) and School Improvement Officers have a key role to help schools address the teenage pregnancy prevention agenda. There is a need to ensure that appropriate training and support to ask the right questions is provided, in conjunction with appropriate data, to support their challenge to schools. Development of the “Secondary PSHCE Curriculum Planning Matrix” with monitoring and auditing tool needs to be started as a priority. We endorse the two day consultation event with Year 8 and 9 pupils to inform SRE development. We recommend that this forms part of a wider and ongoing process of consultation and involvement of young people. There is a need for culturally and linguistically appropriate schemes of work for SRE/PSHCE. – NST can provide support.

46. Key risk factors for teenage pregnancy Risky behaviours Early onset of sexual activity Poor contraceptive use Mental health / conduct disorder/ involvement in crime Alcohol and substance misuse Teenage motherhood Repeat abortions Education-related Low educational attainment Disengagement from school Leaving school at 16 with no qualifications Family / background Living in care Daughter of a teenage mother Ethnicity Parental aspirations

47. Issues and Recommendations Implementation – Targeted Work There is a need for a consistent co-ordinated approach to the early identification of young people at risk. We recommend that risk factors related to teenage pregnancy are explicitly included in all work towards the Common Assessment Framework (CAF). All care plans, pathway plans and reviews should address teenage pregnancy and sexual health issues for Looked After Children and Care Leavers. – RTPC and NST can offer advice. Early identification of those at risk of teenage pregnancy needs to be prioritised and the impact of interventions reviewed. - NST can provide examples.

48. Issues and Recommendations Implementation – Targeted Work There is a need to build on the pilot work in localities on risky behaviours to identify the commonality of prevention work across issues, for example, teenage pregnancy, mental health, emotional health and well-being, alcohol and substance misuse and youth offending, in order to improve targeted prevention work and more effective use of resources. There is a need to develop interventions, particularly with the orthodox Jewish communities and other faith communities. - NST can provide examples. There is an opportunity for localities and neighbourhoods to develop multi-agency targeted preventative work to reduce teenage pregnancy.

49. Issues and Recommendations Implementation – Workforce Training There is a need to develop a Workforce Training Strategy and Plan with respect to the prevention of teenage pregnancy, including mandatory elements of sexual health training, as part of the corporate Children’s Workforce Strategy. We acknowledge the role played by the Teenage Pregnancy Team in providing training. This team needs to be commissioned as part of the corporate Workforce Training Strategy and Plan. All those working with young people, including the voluntary, community and faith sectors and general practice, should have ongoing skills training in relation to talking about sex and relationships to young people, ranging from basic sexual health awareness and signposting training, to more advanced training for those working with the most at risk groups. – NST can provide models of tiered training.

50. Issues and Recommendations Implementation – Workforce Training cont… This training should be commissioned as part of the service contract for Looked After Children and Care Leavers, both within the city and in out of locality placements. There is a need to build upon current work and provide consistent and co-ordinated SRE training to those working with Children in Care and Care Leavers, including foster carers and adopters. There is a need for senior managers in the LA, PCT and schools to encourage the uptake by secondary teachers and community nurses, of the PSHE (SRE) Continuing Professional Development (CPD) accreditation. We recommend that you utilise existing Governor Networks and training opportunities to enable governors to support successful SRE implementation. There is a need to ensure that the training of professionals leads to implementation and better outcomes.

51. Issues and Recommendations Implementation – Integrated services for young people Integrated services for young people have an important contribution to make in terms of raising aspirations, building self-esteem and focusing on positive activities for young people through Integrated Youth Support Services (IYSS) and Targeted Youth Support (TYS). We endorse the plans to review and evaluate the impact of training of Youth Workers to deliver sexual health services. We recommend that this is completed as a matter of urgency to ensure effective delivery of teenage pregnancy prevention. Targeted Youth Support (TYS) developments provide an opportunity to work more closely with those at risk of early sexual activity, sexual exploitation and teenage pregnancy.

52. The issue is complex as there is a range of factors that are associated with whether a teenager becomes pregnant

53. Issues and Recommendations Implementation – Raising Aspirations We commend the work undertaken to date on raising aspirations in Salford. There is a need for all partners to reinforce the explicit connections between raising the aspirations of young people, the prevention of teenage pregnancy, and the agenda for economic and social regeneration. Young people should receive consistent messages from all professionals to raise their aspirations. Further capitalise on the opportunities to raise aspirations through the regeneration of Salford for work opportunities and apprenticeships for young people. This could be supported through collaboration with the Learning and Skills Council and City planners. We endorse the work to develop role models for young people and we recommend building on this to challenge the perception that teenage pregnancy is acceptable and inevitable in some communities.

54. Issues and Recommendations Implementation – Raising Aspirations Utilising the range of awards and opportunities provided by voluntary and statutory youth services, schools, etc should help raise the aspirations of young people e.g. Youth Achievement Awards, COPE (Certificate of Personal Effectiveness), the Duke of Edinburgh Award and peer education.

55. Issues and Recommendations Implementation – Work With Parents & Carers The Salford Parenting Strategy needs to incorporate the prevention of teenage pregnancy within existing parenting programmes in addition to Speakeasy, so that parents and carers feel confident to address young people’s sexual health issues. We recommend that Children’s Centres, Early Years and Extended Services prioritise education for parents and carers on how to talk to their children and young people about sex and relationships, prevention of teenage pregnancy and raising aspirations. It is important to work with parents and carers in communities with high teenage pregnancy rates, to understand their support needs, and challenge attitudes of low aspirations for young people.

56. Issues and Recommendations Implementation – Work With Parents & Carers We recommend the use of existing national resources to support work with parents and carers in talking to their children about sex and relationships e.g. Parentline Plus. Parenting programmes need to be culturally and linguistically appropriate.

57. Priority Actions Please ensure that you refer back to the relevant sections and notes sections for more detail

58. Priority Actions Strategy We would recommend clarifying the roles and responsibilities in relation to teenage pregnancy of the Children and Young People’s Partnership Board, Star Chamber, Teenage Pregnancy Partnership Board, sub groups and strategic lead for Teenage Pregnancy to : ensure long term vision drive the teenage pregnancy agenda strategically make commissioning decisions performance manage the Teenage Pregnancy strategy integrate teenage pregnancy prevention into the wider agenda. We recommend that the Star Chamber review the teenage pregnancy action plan using the Outcomes Based Accountability (OBA) model to ensure it is SMARTER, outcomes focussed and has wider ownership.

59. Priority Actions Data and Needs Assessment There is a need for an up-to-date local young people’s sexual health needs assessment which should feed into the commissioning process on an ongoing basis. There is a need to systematically review local data collection systems and data sharing protocols, to facilitate the routine sharing of information between agencies and allow data sources to be combined for analysis and improved targeting, commissioning and performance management. A local indicator set should be developed to monitor and performance manage delivery.

60. Priority Actions Communication We recommend the development of a specific Teenage Pregnancy Communication Strategy and Action Plan including internal and external communication, media handling protocols, young people’s service publicity and which explicitly links teenage pregnancy prevention to raising aspirations. Implementation There needs to be a Contraception and Sexual Health Joint Commissioning Plan, informed by the Sexual Health Needs Assessment, integrated into wider Children’s Commissioning, and developed in partnership (including with Integrated Youth Support Services (IYSS), Extended Services, Children’s Centres, Training Providers, Building Schools for the Future (BSF) and through the Youth Service Integrated Premises Strategy, which delivers a range of sexual health services in a variety of young people’s settings, available 7 days a week and in hotspot areas.

61. Priority Actions We recommend a Salford-wide Sex and Relationships Education (SRE) approach incorporating policy, training and schemes of work, is further developed and implemented in all secondary schools and all agencies working with children and young people to ensure consistency and quality standards, for example across the 14-19 sector, Pupil Referral Units, colleges, integrated services for young people and social care settings. There is a need for a consistent co-ordinated approach to the early identification of young people at risk. We recommend that risk factors related to teenage pregnancy are explicitly included in all work towards the Common Assessment Framework (CAF). All care plans, pathway plans and reviews should address teenage pregnancy and sexual health issues for Looked After Children and Care Leavers.

62. Summary of support

63. There is a need to establish a clear vision for teenage pregnancy in Salford. A visioning planning session with the Star Chamber would be beneficial. An outcome of this could be a shared set of principles in relation to the objectives of the strategy. - The NST can help facilitate this. We endorse the current review of the TPPB. This needs to be informed by the visioning event and ensure seniority of membership to add further decision makers such as Headteachers/Principals, Governors and School Improvement Officers. All members should prioritise their attendance. - NST can advise on roles and responsibilities. There is a need to review the role of the teenage pregnancy strategic lead within Children’s Services to ensure that they have the capacity and authority to lead, commission and performance manage the Teenage Pregnancy strategy and is accountable to the Star Chamber. - NST and RTPC can provide support and advice. Following the visioning process, we recommend a briefing session for all elected members to ensure they are supported to champion teenage pregnancy issues. – RTPC and NST can help facilitate this.

64. Summary of support We recommend that the Star Chamber review the Teenage Pregnancy Action Plan using the Outcomes Based Accountability (OBA) model to ensure it is SMARTER, outcomes focussed and has wider ownership. – RTPC and NST can provide support. There is a need for an up-to-date local young people’s Sexual Health Needs Assessment to identify the most vulnerable groups and hotspot areas. This should feed into the commissioning process on an ongoing basis. We recommend using the NST Sexual Health Needs Assessment ‘How to’ Guide. – NST can provide examples. A local indicator set should be developed to monitor and performance manage delivery. Indicators should build on those included in the TPU national Teenage Pregnancy Local Monitoring Data Set. – RTPC can support this work. There is a need to prioritise the collection, analysis and sharing of conception and birth data for Looked After Children (LAC), Care Leavers and young people with physical and learning disabilities.– NST can provide further support. There is also a need to gather local intelligence from children, young people and professionals to provide an understanding of why teenage girls in Salford become pregnant. – NST can provide examples.

65. Summary of support We recommend the development of a specific Teenage Pregnancy Communication Strategy and Action Plan building on the Teenage Pregnancy Strategy, which needs to include internal and external communication, media handling protocols and young people’s service publicity. – RTPC and NST can provide examples and advice. Clear and consistent messages need to be developed with, and targeted at, parents, carers and young people most at risk, for example Looked After Children, Care Leavers and those in BME and faith communities. – NST can provide support. There needs to be clear Contraception and Sexual Health Joint Commissioning intentions informed by a Sexual Health Needs Assessment and integrated into the wider Children’s commissioning. – RTPC and SH Network can provide support with this. There needs to be a range of sexual health services in a variety of young people’s settings, outreach and domiciliary, available 7 days a week and in hotspot areas, for example through Extended Services, secondary sector settings, youth services, Children's Centres, community pharmacies, health visiting, midwifery and general practice, voluntary, community and faith settings, Youth Offending Service, Pupil Referral Units and Colleges. NST can provide examples.

66. Summary of support We recommend a review of existing condom provision. The review should be used to inform commissioning and the development of a comprehensive condom distribution strategy which is delivered in a wide range of young people’s settings including voluntary, community and faith organisations, residential homes and foster care provision. – NST can offer support. It is important to ensure the involvement of young people in service development, design, review and implementation, e.g. mystery shopper schemes, patient panels. - NST can provide examples. Review service specification for abortion services to ensure this is consistent with the Greater Manchester Sexual Health Network service specification and includes feedback to referrers on contraception provided to ensure appropriate follow up. - RTPC and the Greater Manchester Sexual Health Network can provide support. Long Acting Reversible Contraception (LARC) should be more widely considered as a first line preventative method with consistent follow up. – NST can offer support.

67. Summary of support We recognise that there is high level commitment to provide strong direction to schools about the importance of SRE and Personal, Social, Health Education (PSHE) to promote proactive engagement of all schools. This process would be supported by work to develop champions. – NST can support with this. We recommend a Salford-wide Sex and Relationships Education (SRE) approach incorporating policy, training and schemes of work, is further developed and implemented in all secondary schools and all agencies working with children and young people to ensure consistency and quality standards, for example across the 14-19 sector, Pupil Referral Units, colleges, integrated services for young people and social care settings. This should incorporate existing local and national guidance. - NST and RTPC can help with this. There is a need for culturally and linguistically appropriate schemes of work for SRE/PSHE. – NST can provide support. Early identification of those at risk of teenage pregnancy needs to be prioritised and the impact of interventions reviewed. - NST can provide examples.

68. Summary of support There is a need for a consistent co-ordinated approach to the early identification of young people at risk. We recommend that risk factors related to teenage pregnancy are explicitly included in all work towards the Common Assessment Framework (CAF). All care plans, pathway plans and reviews should address teenage pregnancy and sexual health issues for Looked After Children and Care Leavers. – RTPC and NST can offer advice. All those working with young people, including the voluntary, community and faith sectors and general practice, should have ongoing skills training in relation to talking about sex and relationships to young people, ranging from basic sexual health awareness and signposting training, to more advanced training for those working with the most at risk groups. – NST can provide models of tiered training.

69. Plenary Session Discussion Local Authority and PCT to comment Questions to clarify feedback points Comments on Feedback Any comments on our process Next steps

70. Support Process

71. NST Support Next Steps Meeting with Chief Executives of the LA and PCT, Director of Public Health, Director of Children’s Services, to negotiate and agree the support to be provided by the NST. Agree tailored package of support.

72. Support Examples of the type of support offered: Visioning/strategy development Performance management models Prioritisation of actions Commissioning sexual health service redesign/standards Sex and Relationships Education – new standards, training, models which can be developed Media/Communications Access to further external consultancy. developing data sets Local areas may wish to negotiate to develop their own business cases to test out pilot work, address a specific difficulty e.g. data collection.

73. Teenage Pregnancy National Support Team Contacts Dr Avril Howarth National Delivery Manager Avril.howarth@dh.gsi.gov.uk07776 244 485 Sarah Carter Sue Jablonskas Associate Delivery Managers Sarah.carter@dh.gsi.gov.uk Sue.jablonskas@dh.gsi.gov.uk 07884 473182 07753 625519 Terri HurlowProject OfficerTerri.hurlow@dh.gsi.gov.uk0207 972 4935 NST Office address : 221 Wellington House 133-155 Waterloo Road London SE1 8UG