Reducing health inequalities among children and young people Director of Public Health Report 2012/13

Contents Summary Setting the scene Antenatal and postnatal period Children of pre-school age Children & y.people with additional needs School age children and young people Children and young people and healthcare

Hastings similar population structure to England but older

Birth and child populations Birth rates increasing over last 10 yrs; but appear to have peaked and will now stabilise or reduce East Sussex 5,400 births in 2010 Highest birth rates are in Hastings (68.9/1, yr olds) and Eastbourne (66/1,000) Hastings consistently higher birth rate than England 21,000 children & young people (0–19 yrs) in Hastings

Relatively deprived Borough 24 (45%) LSOAs in the Borough are amongst the most deprived 20% of areas in England

Children living in poverty Almost one in five (18.8%) across county Ranked 95 th out of 152 top tier LAs in England but highest of 26 two-tier counties Highest % Central St Leonards (47%) Highest numbers in Hampden Park and Langney in Eastbourne Both higher percentage and higher number in urban compared to rural areas

Percentage of children aged under 16 living in poverty, 2010, counties in England Source: HM Revenue and Customs, Child Poverty Statistics, October 2012

Chapter 3: Antenatal and postnatal period Infant Mortality rate higher in Hastings than East Sussex but not statistically significant To reduce infant mortality need to: Reduce under 18 conceptions Reduce rates of smoking in pregnancy - contributes to 40% of all infant deaths; 22% mothers smoking at delivery in Hastings Reduce prevalence of obesity - Associated with a higher rate of stillbirth, prematurity and congenital abnormalities Increase breastfeeding rates - About 49% of mothers B/F at 6-8 weeks; varies with age - 20% in under 20 yrs - 72% in 40yrs & over Reduce child poverty Mental health problems in pregnancy - increase likelihood of parenting problems - new perinatal MH service launched in 2011

Maternal smoking

Chapter 4: Children of pre-school age Immunisation Increase in primary vaccination rates in last 7 yrs, 95% in some areas MMR vaccination rates low at 87% compared to the 95% target Sustained clusters of cases of measles in East Sussex National MMR campaign in progress (PHE) Oral health Improved nationally - rates of tooth decay linked to deprivation Services aimed at reducing inequalities Family Nurse Partnership, Children’s Centres and the new early years and health visiting model (Good Start) all aim to improve outcomes for vulnerable families through early intervention

Priority groups as tend to have poorer health outcomes Looked after Children; children with Child Protection issues, Special Educational Needs and Disability, Not in education employment or training (NEETs) Continued rise in child protection & safeguarding activity over past 4 years resulting in increased demand on social care, health, police and education services ESCC has invested in the THRIVE programme to reduce the number of children subject to child protection plans - concentrates on early help services and family assessment Chapter 5: Children and young people with additional needs

Chapter 6: School age children & young people Educational achievement is a k ey determinant of health 58% 5 A*-C grade GCSEs in 2011/12 – lowest in Hastings (46%) Gaps in attainment: between pupils eligible for free school meals (31%) and others (62%) between those with special educational needs and other pupils Rates of pupil absence & school exclusions contribute to health inequalities – persistent absence higher in East Sussex than England NEET young people impacts on long-term economic well-being & health 387 (3.5%) 16 & 17 yr olds in E Sussex who were NEET in 2011/12, 46% of whom had special educational needs

Schools Health-related Behaviour Survey Undertaken in Spring 2012 with over 4,500, 14 and 15 yr olds, taking part (85% of pupils on school roll) 721 Hastings – 364 boys; 357 girls Previously survey conducted in 2007

Good news Reduction in: Alcohol and drug use & fewer young people start taking drugs at an early age (aged 13 or under) Bullying % pupils who’ve been the victim of violence or aggression in area they live in the last 12 months Increase in: % who know where to get free condoms % who know about local sexual health services for young people

Areas of concern Smoking rates not reduced; increase seen in Hastings Increase in the % saying they are quite or very unhappy with their lives at the moment No improvement in exercise levels Eating habits have worsened Fewer eating 5 portions of fruit and vegetables per day Fewer eating breakfast One in 10 state they never or rarely eat fresh fruit % in sexual relationships has increased Fewer aware re drug & alcohol treatment services for y people

Smoking rates highest in Hastings

Smoking at home highest in Hastings

Alcohol

Drugs

Sexual health

Teenage Pregnancy

Healthy Eating/Healthy Weight

Physical activity

Internet usage and safety

Emergency admissions to hospital In 2 yrs around 15,000 emergency admissions in <18 yrs Children <5 yrs = 78%; 5-9 yrs 12%; yrs 5%; 5-17 yrs 5% Main causes: Respiratory conditions – 20% of all admissions; Unintentional deliberate injuries and poisonings – East Sussex higher than national rate Main causes of accidental and deliberate injury: 0-4 yrs falls (56%) and exposure to inanimate mechanical force (16%); 5-17 yrs falls (49%) and transport accidents (20%) Hastings and Rother have a higher rate of under 18s admissions due to accident or deliberate injury for both 0-4yrs and 5-17yrs, than nationally Chapter 7: Children and young people and healthcare

Hastings & Rother Primary Care Trust among the 20% nationally with the highest rates of:  Admissions for Gastro-Intestinal endoscopy  Hospital admissions for diabetic ketoacidosis in children known to have diabetes  Rate of perinatal mortality The NHS Atlas of Variation in Healthcare for Children and Young People

Recommendations (1) Antenatal and postnatal period PH commissioners: improve performance of stop smoking services and prioritise pregnant women & young people NHS Maternity service commissioners: monitor BMI and offer information and support on weight management; provide more B/F support for y women & in more deprived areas NHS England: Improve vaccination uptake

Recommendations (2) Children of pre-school age PH commissioners to work with primary care to improve immunisation up-take & make recommendations to NHS England Commissioners for Children's services to ensure: FNP effective in improving performance in smoking cessation, low birth weight, A&E attendances, use of Long Acting Reversible Contraception Good Start model meets local needs & improves care for vulnerable families Children’s Centres work to improve health of the most vulnerable and deprived communities

Recommendations (3) Children with additional needs LA & NHS commissioners to prioritise the needs of looked after children PH commissioners to ensure health improvement interventions are targeted at most vulnerable families through THRIVE programme LA commissioners to evaluate parenting groupwork and early help services as part of THRIVE programme

Recommendations (4) School age children and young people LA commissioners, schools & academies - ensure whole schools approach to healthy lifestyles; focus on smoking, exercise, healthy eating & emotional health Schools & Academies, PH commissioners - ensure y. people aware re accessing sexual health services PH commissioners - evidence-based weight mngt services for obese children & their families

Recommendations (5) Children and young people and healthcare Public Health Commissioners to support households at greatest risk of accidents at home, including provision of home safety assessments Clinical Commissioning Groups to review areas where hospital service use appears to be relatively high, to ensure that commissioning is cost effective

Thank you Any Questions