1. Children and Young People Health and Wellbeing in Greater Manchester

2. Children and Young People Health and Wellbeing - Overview Early Intervention and prevention – the circumstances in which children grow up will influence their future health and wellbeing. Changed roles and responsibilities in the NHS since 1 st April 2013. Significant variation in health and wellbeing outcomes for children and young people. Use of health services - Greater Manchester has very high rates of child emergency hospital admissions for long- term conditions. Transitions - arrangements for transition between services for children and adult services can be

3. Early Intervention and Prevention Conception to age 2 –the age of opportunity How we treat 0-2 year olds shapes their lives – and ultimately our society. Loving, secure and reliable relationships with parents, together with a quality home learning environment foster a child’s: Emotional and mental wellbeing Capacity to form and maintain positive relationships with others Language and brain development (c. 80% developed by age 3) Ability to learn WAVE Trust April 2013 Also see NICE Guideline 40

5. Early Intervention and Prevention Conception to age 2 –the age of opportunity – What we need to ensure:  Healthy pregnancy – reduced maternal stress, drug and alcohol misuse, good diet  Adequate infant nutrition, particular benefit of breastfeeding  Good hygiene, home safety and immunisation  Earlier identification of need and provision of appropriate support  Intervene early to promote infant mental health  Full delivery of Healthy Child Programme with focus on promoting social and emotional development  Targeted work in Children’s Centres  Quality provision in early years services and settings Well implemented, evidence based preventative services and early years interventions are likely to do more to reduce abuse and neglect than reactive services AND deliver economic and social benefits.

6. Early Intervention and Prevention GM Early Years New Delivery Model Work is underway to develop:- 1.Single outcomes framework 2.8 Stage Assessment – standardised assessments used at key stages from pregnancy to school, identifying needs and measuring progress 3.Evidenced based interventions – delivered routinely and at scale 4.Good use of Daycare, notably targeted two’s offer, with an education, work and skills ‘contract’ for parents 5.Well equipped workforce from maternity to schools 6.Data systems that support practice and track impact 7.Long term evaluation Ref Early Years Business Case Oct 2012

7. NHS England Public Health England/ Department of Health NHS England – Local Area Team Clinical commissioning groups/ local authorities public health Local authorities Schools Police and Crime commissioner

8. Vision for a local Healthy Child Programme: pregnancy to 19 Pregnancy to five offer 5 to 19 years offer

9. A ‘good’ local programme will improve these key outcomes: Foundation Stage Scores – narrowing the gap Infant mortality – LE gap Low birth weight Teenage pregnancy rate Childhood obesity Reduced A&E attendance & hospital admissions Reduced vulnerability of individual children and families (less CiN, less CPPs, less LAC) Also: breastfeeding, smoking in pregnancy, immunisations & screening, smoking by YP, improved mental health YP, Outcomes for LAC

10. The health and well-being of children and young people –  Begins before birth  Is affected by a range of factors including social, familial and biological/physical  Carries implications for later adult life The following illustrates the GM position in relation to England on several key measures: Red figures denote GM is worse and green denotes better than England. Children and Young People’s outcomes

11. Pre-birth MEASUREGM AVERAGE ENGLAND AVERAGE # Conceptions (per 1,000 under 18yr olds: 2011)37.830.7 *Infant deaths (per 100 live births carried to term: 2009-2011) 4.84.4 ^Mothers smoking at time of birth (per 100 births: 2012/13) 15.612.6 Sources: # ONS Conception statistics:* www.phoutcomes.info: ^ www.hscic.gov.uk

12. Wider determinants MEASUREGM AVERAGE ENGLAND AVERAGE ~ Lone parent households (% of population: 2011) 14.011.7 $ Children living in poverty (% of population: 2010) 23.921.1 MEASUREGMENGLAND Total & Domestic violence (number of recorded incidents: 2011/12) 47,496 (6% of England total) 745,105 Sources: ~ ONS 2011 Census: $ ChiMat: & ONS Crime Statistics

13. Outcomes MEASUREGM AVERAGE ENGLAND AVERAGE *School ready (% of population: 2011/12)61.364.0 *Obesity at 4-5yrs (% of population: 2010/11 )22.422.6 *Obesity at 10-11yrs (% of population:2010/11)35.533.4 + Deliberate and unintentional injuries under 18yr olds (per 10,000 <18yr olds: 2010/11) 147.9124.3 Sources: * www.phoutcomes.info: + www.apho.org.uk

14. Levels of need High need Low Numbers Low need High Numbers 69,000 36% 3.6% 0.48% 0.29% CPP LAC CiN Vulnerable All children

15. Primary Care Children and young people make up a significant proportion of patients seen in primary care. Ensuring that primary care services are able to communicate effectively with children and young people is key to helping then manage their health. Children and young people need to be aware of the services they can access and their right to universal health services. For Children and Young People with long-term chronic conditions communication with primary care is key to good self management.

16. Secondary Care Greater Manchester has very high rates of child emergency hospital admissions for long-term conditions. Rates of admissions for asthma and epilepsy are significantly higher than the England averages. For asthma and epilepsy emergency admissions rates increase as levels of deprivation increase – but there is no relationship between deprivation and emergency admissions for diabetes. When compared with statistically similar areas – many parts of Greater Manchester have much higher rates of hospital admissions.

17. Transition into Adult Services _ Barriers coordinated approach to transition, including lack of multi-agency working ● lack of a holistic approach ● lack of information for young people and parents ● insufficient attention to the concerns of the young person ● lack of appropriate services onto which young people can transfer.

18. Set up Dec 2010 in response to lack of referrals from local A&E to Mosaic Paediatric Liaison Nurse screens attendances daily for substance misuse attendances and refers to Mosaic (treatment /school based worker) 175 referrals in first 18 months 41% at Stockport Schools & 96% of these were engaged in intervention in school Remainder contacted by letter, with further active follow- up for higher risk cases Only 5 repeat attendances within first year Stockport A&E Pathway for Under 18’s

19. Trafford case study Trafford commissions Phoenix Futures who run an 11-25 YP service Issues of drugs (mainly Cannabis) and alcohol used together by Young People as a means of coping Involving Young People in Care/Recovery Plans so they take ownership Extended service from 11-25 means a range of risky behaviours can be addressed in an holistic way Encourage healthy lifestyles such as access to community facilities such as gym and nutritional information Structured use of time by affording access to college courses and work opportunities Dedicated PbR funnels ensure core areas within a YPs life are addressed via an individualised care plan which considers offending and employment which will impact on health of YPs Access to Counselling services, where required Consider mental health provision beyond 18 when CAMHS will cease and how this may impact on YP misuse of alcohol and drugs. The service have engaged in a number of prevention sessions within schools to raise awareness

20. ‘The true measure of a nation’s standing is how well it attends to its children – their health and safety, their material security, their education and socialization, and their sense of being loved, valued and included in the families and societies into which they are born’ Child poverty in perspective: An overview of child well-being in rich countries UNICEF 2007

21. Group Exercise What needs to change to make the transition between services work better for children and young people?