Hertfordshire Health & Wellbeing Conference: Starting Well Dr SJ Louise Smith Sue Beck Public Health, Hertfordshire County Council Jacqui Bunce East & North Hertfordshire CCG

Introduction Increasing population 77,000 children <5 13% live in poverty Future challenges –Inequalities –Integration –Finances

Children's Health Needs Mortality Inequalities school readiness & attainment No breastfeeding data –Smoking –Mental Health

Starting Well – Context National Review of Maternity Services BME profile changing Teenage Pregnancy rate is falling Population – demographic changes Older first time Mums – associated risks Link to Domestic Violence Parity of esteem

High impact areas Smoke free homes Breastfeeding Diet & healthy start vitamins Safe sleeping Maternal mental health Stop smoking in pregnancy Immunisation uptake Illnesses

Starting Well draft priorities Priority 1 We will implement a cross system strategy to reduce tobacco related deaths in the < 5s

Reducing smoking in pregnancy

Priority 2- We will bring services together to integrate assessment & care planning Teenage Pregnancy & advice/support Maternal Health –Obesity – Diabetes –Perinatal mental health –Smoking prevalence Support for expectant mothers who are caring Midwifery & ante natal care Support & education for expecting parents who have mental health problems or a LD Family Nurse Partnerships

Diet & Vitamins Breastfeeding Normal growth Weaning Vitamins Obesity

Priority 3-We will implement an integrated approach to parenting support Changes to Maternity Services Birth experience Breast Feeding Post natal care –Screening – hearing loss –Post natal depression Transition from midwife to Health Visitor support Children's Centres & other post natal support

Cot deaths & Safe sleeping 30 deaths since 2009 Smoking Drugs & Alcohol Co-sleeping Overheating

Priority 4- We will implement early interventions and accessible, appropriate services to support maternal mental health Around one in ten women experience mental health problems during pregnancy and the first year after childbirth Perinatal mental health problems make a significant contribution to both maternal and infant morbidity and mortality Suicide is one of the leading causes of maternal death in the UK. Women who need inpatient care for a mental health problem within 12 months of childbirth should normally be admitted to a specialist mother and baby unit Expert early identification and management of perinatal mental health problems should prevent women reaching the point where they need inpatient care There is commissioning challenge to ensure equity of access for specialist perinatal mental health services

Integrated Children's Commissioning Framework Partnership High quality services Needs & evidence based Child & Family Centred Prevention & Universal

Who and What? Schools & education Voluntary Sector & Wellbeing –Sexual health, smoking Antenatal & Midwives 0 – 5 Healthy Child –Health visitors & FNP –Immunisation –Screening –Surveillance & data NHS services –GPs, acute & community Children's Centres & child care Schools, SRE E.g. NCT, Banardos Public Health, County Council CCGs, Acute & Community NHS Providers NHS England, GPs Antenatal, neonatal, HV Child Health Information service Children’s services

0 – 5 Healthy Child Programme Universal Child & family Routine review Development checks Assess need and identify early Parenting Immunisation & screening Data

To recap A future HWB strategy - suggestions Priority 1  We will implement a cross system strategy to reduce tobacco related deaths in the < 5s Priority 2  We will bring service together to integrate assessment and care planning Priority 3  We will implement an integrated approach to parenting support Priority 4  We will implement early interventions and accessible, appropriate services to support maternal mental health

Discussion How do we tackle these challenges together? Comments or feedback to:

thank you