ChiMat: Looking forward: Challenges in improving outcomes in maternity and early years Dr Helen Duncan ChiMat Programme Director June 2012

Maternal conditions Hospital Episode Statistics

Maternal mortality Percentage of maternal deaths due to direct and indirect causes, Centre for Maternal and Child Enquiries, CMACE

Trends in infant mortality 3,700+ registered users 2,300+ registered users

Infant mortality by socio-economic group 3,700+ registered users 2,300+ registered users

Children and Young People’s Health Outcomes Forum :Role The Forum, jointly chaired by Christine Lenehan and Professor Ian Lewis was launched on 26 January and will be reporting to the Government with independent advice later this year on: – the health outcomes that matter most for children and young people – how well these are supported by the NHS and Public Health Outcomes Frameworks – how the different parts of the health system will contribute and work together in the delivery of these outcomes

The Health Reforms NHS commissioners supported by a new NHS Commissioning Board will authorise CCGs, commission some services including primary care, and host clinical networks and senates Most NHS care commissioned by Clinical Commissioning Groups All NHS providers to become Foundation Trusts A stronger role for local authorities in shaping services, with new responsibility for local population health improvement New Health and Wellbeing Boards within each higher tier local authority area

Children and Young People’s Health Outcomes Forum; Engagement The Forum is organised by the following themes and leads: – Public Health and Prevention: Ann Hoskins & Barbara Hearn – Acutely Sick Children: Carol Ewing & Eric Kelly – Mental Health: Lisa Christensen & Margaret Murphy – Long Term Conditions: Colin Green & Gillian Baird National Children Bureau’s work to gather evidence on the views of children & Young People National, regional and local events Focus Groups looking at specific issues and communities Online feedback via

Maternal obesity Impact of maternal obesity -5 % BMI > % in most deprived quintile -Risk type 2 diabetes in BME 3.5 X -Risk gestational diabetes in BME 1.6 X -More C-sections in BME -More deliveries before 37 weeks in BME CMACE 2010 Measuring levels of obesity in first and subsequent pregnancies Levels of obesity at 16 – 17 years

Smoking in pregnancy Strongly correlated with Deprivation Teenage mothers Best in country – 3.1% Worst in country – 32.7% Measuring smoking quit rates during pregnancy and establishing which interventions work

Breastfeeding Breastfeeding at 3-4 months Nutrition and vitamin D deficiency Breastfeeding initiation, younger mothers Breastfeeding continuation, older mothers Breastfeeding initiation versus deprivation

Postnatal care Newborn babies (well babies) coming back into hospital system more often, as outpatients and as admissions An issue to track and for further investigation

Early Years – policy backdrop Healthy Child Programme: 0- 5 years, 2009 Healthy Child Programme: 5 – 19 years, 2009 Healthy Lives, Healthy People: our Strategy for Public Health, 2010 Independent Review on Poverty and Life Chances – Frank Field, 2010 Early Intervention: the next steps – Graham Allen, 2011 Health visitor implementation plan : a call to action, February 2011 Fair Society, Healthy Lives: the Marmot Review, 2011 NHS Outcomes Framework, 2011 Public Health Outcomes Framework, 2012

PREview – it’s complicated PREview: Investing in children’s services for a fairer future Analysis of Millennium Cohort Study Outcomes aged 5 – health, learning & development and behaviour Associated factors available during pregnancy and early infancy Forward looking, evidence based population modelling Resources for professionals to use with families and communities

Early Years - issues Most prevalent risk factors (from the Millennium Cohort Study) Forum discussions o Maternal mental health – previous history recorded during pregnancy o Maternal mental health – postnatal depression o Maternal self efficacy o Parent /child relationships o Child wellbeing Type of riskVariable% of families Depression Either mother or father often feels depressed 19.4 Physical disability Either mother or father has a longstanding illness that limits daily activities 15.0 Alcohol At least one of the parents is at risk of alcoholism (> 14 units women, > 21 units men) 12.3 Substance misuse Mother smoked during pregnancy 11.7 Teenage parenthood Mother was < 20 years for their firstborn child 11.1

Early Years - outcomes Child Development Outcome, aged 2 – 2 1 / 2 years School readiness, aged 5 years School attendance, aged 5 to 18 years Educational attainment, aged 11 to 18 years Not in Education, Employment or Training, aged 16 to 18 years First time entrants to youth justice system, aged 10 to 17 years Self reported wellbeing Self reported health behaviours The earlier the investment or intervention the greater the Return on Investment

Child Development Outcome, aged / 2 years Aim o Screening tool to identify additional needs at individual level o Results can be used to track improvements at a population level, monitor via Public Health Outcomes Framework Use of Healthy Child Programme 2 – 21/2 year review o Commissioning arrangements variable o Coverage variable – average 70 % o Age targeting and minority targeting variable Use of approved assessment tools o Some good practice in place o Too many home grown tools in use o Favourites in use and in planning o Ages and Stages Questionnaire – ASQ o Parents Evaluation of Developmental Status – PEDS Implementation o With expanded Health Visitor workforce o With maternity and child health secondary uses dataset

The new system RisksPotential Solutions Fragmented commissioningHigh level service specifications Commissioning Outcomes Framework Keeping focus on children and young people A lead for CYP in all new organisations at both national and local level Building in the Children’s voiceIn authorisation specifications Multiple agencies involved Determinants of health very wide ranging National level – cabinet sub-committee on public health Local level – Health & Wellbeing Board to bind all together Urgent and primary careGPs trained in paediatrics

Some recommendations Linking across sectors – health, education, social care o Better sharing of information o Use of unique identifiers Child Health Information Systems o Responsibility placed with NHS Commissioning Board o Clinical specification approved and published Electronic child health records - technology o Accessible by professionals, patients, parents and carers o Use in real time o Enabled by mobile technology Child Health Records - content o Contains mothers background information, medical history and o record of unborn baby o Contains care plans for all children with disability, long term or o complex conditions Information for the patients and public o Single source, approved, evidence based

For more information Contact your ChiMat Local Specialist