Healthy lives, brighter futures – The strategy for children and young people’s health Fiona Smith Adviser in Children’s & Young People’s Nursing, Royal College of Nursing, United Kingdom The voice of nursing in the UK

Healthy lives, brighter futures is a joint strategy

A healthy childhood is critically important Improving children and young people’s physical and psychological health, by investing in children’s health from the early years, through childhood and adolescence, will benefit children, families, society and the NHS. Children and young people are healthier than ever before Supported by medical, technological, social and economic advances Helped by more information and support for parents and more skilled professionals To address inequalities, current trends and public concern The past decade has seen continued improvements But we need to do more to become world-class The Strategy cements standards and ambitions

The Child Health Strategy Reflects PSA priorities to: –Reduce inequalities in infant mortality –Reduce teenage pregnancy –Increase uptake of breastfeeding and reduce obesity –Reduce experience of bullying –Reduce hospital admissions for children’s injuries –Reduce preventable child deaths –Improve services for CAMHS and disabled children

The Child Health Strategy Cements standards and ambitions: –The NSF for Children Young People and Maternity Services –High Quality Care for All, NHS Next Stage Review –Every Child Matters –The Children’s Plan and reflects the concerns people raise as: –Children and Young People –Parent and Carers –Practitioners

Four principles underpin improving users’ experience of services from birth to 19 Public sector provide healthy settings and encourage healthy choices Healthy opportunities The right services Responsive services Extra support for those vulnerable to poorer health outcomes Targeted support Information for mothers, fathers and carers Informed users

Continued improvement to services to support families from pregnancy onwards World-class health outcomes Services of the highest quality Excellent experiences in using services Minimise health inequalities Support to parents to give their children a healthy start and partners to deliver change in every area Achieve long-term aims for children and young people’s health Pregnancy and the early years School-age children Young people Children with acute and additional needs Delivery systems transformation

The scale of the health problem High prevalence of risk factors compared to other European countries (e.g. births to women under 20 years of age; women smoking during pregnancy Risks are not distributed equally; links to deprivation and with a growing impact of economic recession Our rising birth rate, relatively high incidence of teenage pregnancies and rising proportion of pregnancies in older women means more risk to manage and a growing target group for health promotion. Increased hospital activity and preventable child deaths

The scale of the health problem 1.1 million children with asthma in the UK (3 children in every classroom) Type 2 diabetes likely on the increase as a result of the increased proportion of obese children Disability services lack consistency across the country, with evidence of unmet need Significant prevalence of mental and emotional disorders with consequences for educational outcomes

Neonatal and infant mortality: key facts Reductions in infant mortality (1970 to 2006) in England & Wales to 5 per 1,000 live births are: leveling off unevenly distributed (inequalities by region, maternal age and country of birth) a poor position compared to other European countries Range of actions needed to impact on closing the gap in infant mortality, e.g. reducing conceptions in under-18s reduce overcrowding in the routine and manual socio-economic group reduce the rate of smoking in pregnancy reduce the prevalence of obesity and improve infant nutrition early booking and optimal pre-conception care England’s neonatal mortality rate of 3.4 deaths per 1,000 includes wide variations, from 1.8 in Surrey and Sussex to 4.8 in South West Midlands

Long-term conditions and hospital activity: key facts Emergency admissions have increased over the past decade in the 0-19 age group Over 800, 000 emergency admissions of children and young people in England every year, with wide variations in rates at PCT level Long term conditions accounting for high numbers of emergency bed days are asthma, diabetes, epilepsy, cystic fibrosis and sickle cell disorders Children in England have one of the worst incidences of type 1 diabetes and one of the worst records of diabetic control

Long-term conditions and hospital activity: key facts Opportunities for health gain: the example of asthma: –over past six years, average of 27, 500 hospital admissions each year for asthma in 0-18s –cost of treating a child with asthma exceeds adult asthma treatment cost –the more deprived a child is, the more likely that the child will attend A&E for an asthma-related admission –an estimated 75% of current asthma related childhood hospital attendances are avoidable

Disability: key facts Research suggests 3 to 5.4% of under-18 population has a disability Outreach work is extending into community settings: family homes; schools; extended schools; children’s centres Large variation across PCTs in support systems available to families to improve quality of life for families Parents of 39% of children aged over 5 tell us that their child has unmet leisure needs

Mental health: key facts 1 in 10 children has a mental disorder 4% of children have an emotional disorder Children with emotional disorders were more than twice as likely as other children to have had unauthorised absence from school (21% compared with 9%) The UK ranked bottom amongst developed counties (OECD) for subjective wellbeing indicator

The prevalence of mental disorders is greater among children and young people in certain family-types:

Sexual Health: key facts Teen infection almost doubled during 90s The sexual health of adolescents in the UK is poor. It is likely that an increase in risky sexual behaviour has contributed to sexual health outcomes such as STIs and unwanted pregnancy among young people.

Alcohol consumption is rising

.. And Britain leads the way Health Behaviour of School Age Children

Smoking Health Behaviour of School Age Children

Sexual Health

Teenage pregnancy rates are falling – but not fast enough

Prevalence of obese children by parental obesity

Actions: School-age children + Young People Healthy child programme for school- age children to be developed National Healthy Schools Programme to be strengthened PE and sport in schools to be increased (Olympics)

Actions: School-age children + Young People Extending free school meals to more children Personal, Social, Health and Economic education to be improved and statutory ‘You’re Welcome’ standards to be rolled out Increase young people’s knowledge of effective contraceptive services in a range of settings

Looking back Why was the school medical service founded in the UK? Poor health of recruits for the 1 st World war Workforce calculations 1 school nurse was needed for every 2,500 children

The school nurse: is a specialist practitioner working across education and health provides the link between school, home and the community needs to have advanced and specialist knowledge and skills to meet the needs of children and their families

The role of the school nurse: health promoter health educator works in collaboration with others such as teachers, youth workers and counsellors provides access to confidential advice and guidance on a range of issues enables and empowers young people to make healthy life choices which affect them throughout their lives

The school nurse: delivers on health priorities by providing information about areas such as good nutrition, exercise, smoking, mental health, drugs and sexual health identifies vulnerable children and young people, implementing early interventions and referring to specialists and other sources of support when required Health Priorities Accidents alcohol and drugs smoking cessation mental health obesity, nutrition and physical activity sexual health and teenage pregnancy. safeguarding and promoting children and young people’s welfare

The role of the school nurse: shaping and influencing policies across the school environment to tackle issues such as bullying, the provision of safe drinking water and clean toilet facilities drop-in advice sessions enable direct access to health information from a nurse

They used to check for nits, but 60 years after the NHS was founded school nurses have a very different role…….. School Nurses today ………..

Children and young people are a high priority Challenges persist –e.g. Infant mortality, teenage pregnancy, hospitalisations, LTC management, disability, mental health New challenges arising –e.g. Obesity, autism, service redesign, NHS reform Unacceptable variations in risks and outcomes Children’s early experiences can have lifelong consequences: How do we ensure prevention early intervention and support No room for complacency: The Child Health Strategy is the vehicle for making it happen

Investing in school nursing - long term outcomes School nursing is a universally accessible service, non stigmatising and acceptable to most families and school communities Investment in school health services has the potential to make a considerable difference to health of the future population

The RCN position The RCN recognises the importance of school nursing The RCN school nurse campaign calls for a need to invest in school nursing services The RCN wants to see a qualified nurse in every school

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