1. Francesca Entwistle Regional Infant Feeding Co-ordinator DH London Francesca.entwistle@dh.gsi.gov.uk L Dyson, F McCormick, Professor MJ Renfrew

2. London Breastfeeding Mapping Project RPHG-L Francesca Entwistle MIRU Lisa Dyson (Project Lead) Felicia McCormick, Professor Mary Renfrew ChiMat Dr Helen Duncan, Steven Chaplin Children’s Services Mapping Diane Barnes, Stephen Bradley, Ethna Parker Infant Feeding Leads London

3. Purpose of session 1.London Breastfeeding Mapping Project 2.Project outputs and preliminary findings 3.National Breastfeeding Mapping

4. Project Aims Planning and commissioning of local services on basis of need Over time, planning and commissioning/de-commissioning of local services on basis of ‘what works’ To provide a directory and map of services across London for health professional and service users

5. Project Objectives Collection of core data on breastfeeding services across London Identification of demographic, breastfeeding behaviour and health outcome data Development and testing of bespoke database to map all data variables

6. Methods On line questionnaire designed by research team and commissioner utilizing an embodied knowledge of breastfeeding and expertise in research design Site designed by Children’s Services Mapping, University of Durham Data collected on line by Infant Feeding Leads 9.30-4.30 daily helpdesk available to ‘mappers’ Demographic, breastfeeding and health outcome data incorporated by ChiMat

7. Coverage PCTs n/31 (%) NHS Trusts n/24 (%) Total Trusts n/55 (%) 26 (84)24 (100)50 (91) Organisations with a registered mapping lead 27 September 2009

8. Electronic outputs (1) Children’s Services London Breastfeeding Mapping web pages: –PCT profile http://www.childrensmapping.org.uk/breastfeedinglondo n/results/pctprofile.php –Results tables by Trust / breastfeeding service http://www.childrensmapping.org.uk/breastfeedinglon don/results/live.php

9. Electronic outputs (2) Children’s Services London Breastfeeding Mapping contd/… Service Directory for women from November 2009 www.childrensmapping.org.uk/breastfeeding london/services/distance(borough/PCT)

10. Electronic outputs (3) ChiMat instant atlas London breastfeeding mapping website –PCT London breastfeeding mapping profile –Single map –Double map http://yhpho.york.ac.uk/IADataServer/MapSele ct.asp

11. Interpretation of services data (1) A snapshot of service data at 30 June 2009 to assess current service provision against local need 2009 dataset provides baseline for monitoring change in service provision against need over time No validation of breastfeeding services data

12. Interpretation of services data (2) Problems attributing service use to the PCT Double or triple counting of services from acute Trusts providing services to women from several PCTs High mobility of individuals and routine cross- border movement in London

13. Interpretation of services data (3) Pragmatic analysis of ‘what works’ Acute services apportioned to a PCT on basis of number of births in PCT for ChiMat service data Time lag between service data and outcome data –6 months for breastfeeding outcomes –18 months for health outcomes

14. Results (1) Services registered by PCTs n=26/31 Services registered by NHS Trusts n=24/24 Total 119147266 Number of breastfeeding services registered by Trust

15. Results (2) Number of breastfeeding services by PCT

16. Results (3) Type of TrustPolicy on breast- feeding Policy banning promotion of use of formula Policy banning inclusion of formula samples in packs PCT (n=31)19 (61%)15 (48%)10 (32%) Acute (n=24) 19 (79%)18 (75%)19 (79%) Number of Trusts with breastfeeding policies

17. Results (4) Mix of breastfeeding services by Trusts Type of servicePrimary Care Trust * Acute care Trust* Total* Information services59 (24%)94 (23%)153 (23%) Education services39 (16%)76 (18%)115 (17%) Support services37 (15%)60 (15%)97 (15%) Education and support services51 (20%)79 (19%)130 (20%) Clinical services46 (18%)85 (21%)131 (20%) Other19 (8%)20 (5%)39 (6%) Total251414665 N = number of services (% of total services for type of Trust)

18. Results (5) Type of TrustTrusts delivering targeted services Total services registered Targeted services PCT (n=31)8 (26%)1199 (8%) Acute (n=24) 7 (29%)14712 (8%) Targeting of services by Trusts

19. Results (6) Number of breastfeeding services by deprivation

20. Results (7) Deliveries among women <20 years for 2007-08

21. Results (8) Type of Trust Delivery of peer support services Total services registered Number of peer support services PCT (n=31)15 (48%)11937 (31%) Acute (n=24)10 (42%)14720 (7%) Number of Trusts delivering Peer Support services

22. Results (9) Type of TrustTrusts with current or planning service evaluations Total services registered Current or planned evaluations of services PCT (n=31)19 (61%)119 40 (33%) Acute (n=24) 17 (71%)14752 (35%) Impact evaluation of services by Trusts

23. Results (10) Older mums and sustaining breastfeeding

24. Results (11) Births by caesarean section for 2007-08

25. Results (12) Duration of breastfeeding at 6-8 weeks for quarter of Jan 2009 by number of breastfeeding services

26. London Breastfeeding Profile Results (13)

27. National Roll Out Sustainable national rollout as part of Children’s Mapping Service November – February data collection Adapted mapping tool and model Publication of Atlas Mapping continues…

28. Recommendations 1.Evaluation of the utility of mapping tools by PCT commissioners 2.Evaluation of the views of pregnant and breastfeeding women and their families of the service directory 3.Comparative research to evaluate the London mapping to the national programme 4.Assessment of costs for maintaining and updating a national breastfeeding services mapping dataset 5.Evaluation of cost of services related to impact on breastfeeding prevalence over time.

29. Implications for policy and practice 1.The project should be adequately funded to continue as a pilot in the London area 2.Policy and financial support is required to promote the effective uptake of and provide training on appropriate use of mapping tools 3.Policy and financial support for appropriate evaluation 4.Future national mapping services should take into account findings of the proposed evaluations to ensure development of the tools, to inform improved planning and commissioning

30. London Pilot: pioneering, ground breaking work Any questions? Thank you