Children and Young People Committee
CYP(4)-03-11 – Paper 2
Child Health: Evidence from the Minister for Health and Social Services
Purpose
1. This paper provides background information to inform the Children and Young People’s Committee’s discussion with the Minister for Health and Social Services at its meeting on 29 September 2011.
2. As requested, the paper provides details on aspects of child health, including NHS service provision, the general health of children, specific children’s medical conditions, and Flying Start.
Introduction
4. Many of the priorities for the Health, Social Services and Children’s agenda for this Assembly were set out in Standing up for Wales.
5. In relation to the NHS, our manifesto commitments have a clear focus on giving children a healthy start in life. More widely, we want to ensure children receive the care they need as close to their homes as possible in an integrated, safe and sustainable health system.
6. We have made clear our commitment to improve outcomes for children. The Rights of the Children and Young Person’s Measure 2011 places a clear duty on Welsh Ministers to show due regard to the United Nations Convention on the Rights of the Child. This provides for Welsh Ministers to prioritise the rights of Children and Young People and to improve outcomes across portfolios, including health and wellbeing.
7. We are doing this through our programme of health and social interventions, responding to the evidence base in the Marmot, Allen and Field Reports which clearly show that prevention and early identification and intervention, along with addressing the social determinants of health, are an essential investment in the future of each child.
8. This also includes our commitment to doubling the number of children and their families benefitting from Flying Start – including increased levels of health visiting.
8. Details on our priorities for the health of children in Wales are set out in Annex 1.
ANNEX 1: CHILD HEALTH
The manifesto sets out the programme for Government over the next five years and includes a range of commitments in relation to the health agenda, including the health of children, which build on, enhance and embed work already underway. We are delivering on a number of initiatives to improve child health.
(i) Expanding Flying Start
The Flying Start programme is one of the ‘Five for a Fairer Future’ Manifesto pledges. The programme is predicated on evidence that, for children from disadvantaged families, investing in quality interventions and experiences during their early years will have a direct impact on their health. We want to ensure that children have the best start in life and as part of this we will be doubling the number of children benefitting from improved health visiting, free nursery places and better support to families through our Flying Start programme; and extending the reach of the programme and doubling the number of those gaining from Flying Start to 36,000, so that almost a quarter of all children in Wales aged 0-3 will be able to benefit.
(ii) Improving Protection and Child Health
It is a Welsh Government priority to forcefully take forward the public health agenda and to encourage parents to take greater responsibility for their own and their children’s health.
Our Healthy Future(OHF) is the Welsh Government's Public Health Strategic Framework to 2020. Giving Children and Young People a good start in life that supports their long-term health and wellbeing is one of the OHF themes. This theme is also central to the Welsh Government’s Fairer Health Outcomes For All (FHOFA), a Reducing Inequities in Health Strategic Action Plan. This outlines a set of practical actions which embed addressing the social determinants of health in public health work. It also links with our Child Poverty Strategy. This Strategy gives a clear account of what the Welsh Government can achieve in helping to reduce child poverty – and improve the outcomes of low income families, which will directly impact on child health.
Drawing on OHF,FHOFA and the Child Poverty Strategy, the 2011/12 Annual Quality Framework identifies protecting and improving the health of children and young people as a key action. By the end of 2011 /12, each Local Health Board (LHB) must deliver against the targets for which the organisation is responsible within its local Children and Young Persons’ Plan, and especially those targets relating to child health, health inequities and child poverty. More specifically, there is to be demonstrable local progress with achieving the child poverty targets relating to infant mortality, low birth weight and teenage conceptions.
In terms of specific public health issues, we are particularly focussing on screening, immunisation, healthy eating and obesity, smoking, sexual health and wellbeing and healthy schools.
Fetal, Maternal and Child Health Screening
Antenatal screening tests are offered for: HIV, hepatitis B, syphilis, rubella susceptibility, sickle cell and thalassaemia, Down’s syndrome, rhesus antibodies, and the provision of early and mid pregnancy ultrasound scans. LHBs and Public Health Wales are working to strengthen the programme and implement new tests for newborn bloodspot screening. This includes a review of Duchenne Muscular Dystrophy (DMD) testing at the behest of the Medical Director. The Newborn Hearing Screening programme was introduced in Wales in 2003. All babies are screened within 6 weeks of birth. The screening programmes form part of the suite of national population screening programmes delivered by Screening Division, Public Health Wales.
Immunisation
Nationaluptake of all routine immunisations in one-year-old children exceeds the 95% target. Uptake for the 5 in 1 vaccine MeningitisC (MenC) and pneumococcal conjugate vaccines (PCV) continues to increase, and the level for doses in children at five years of age is now higher than it has ever been. Most recent figures show that uptake of the first dose of MMR vaccine in two year old children was 91.6%; uptake of the second (MMR) dose by five years of age remained at 87%; and uptake of MMR pre-school booster in five year old children was 90%. As at May 2011, uptake of first dose of Human Papilloma Virus (HPV) vaccine in girls in the 2010-11 School Year 8 was 86%, and uptake of the second dose was 81%.
Healthy Eating and Obesity
By raising the rates of breastfeeding in Wales, children can have a healthier start in life. The National Breastfeeding Programme aims to address the unequal incidence of breastfeeding amongst the population in Wales and to raise public awareness of the importance of breastfeeding. The programme targets support at three levels: the NHS; the community; and families. It includes the provision of a grant to the UNICEF UK Baby Friendly Initiative to provide a professional officer to support maternity, health visiting and other community services across Wales. Grants are also provided to all local health boards for local strategic co-ordination of Support Groups, Peer Supporter training and the Breastfeeding Welcome Scheme.
Healthy Start is a statutory UK wide scheme, managed by the Department of Health (DH) on behalf of the UK. The scheme provides weekly vouchers, currently worth £3.10 each, towards the cost of milk, fresh fruit, fresh vegetables and infant formula milk at participating retail outlets. Two Healthy Start branded vitamin supplements are also available through the NHS without prescription for pregnant women, new mothers and children on the scheme. Over the last 18 months the Welsh Government has funded a pilot to provide free Healthy Start vitamins to every pregnant woman and to every child aged 0-4 years in Cardiff to address health professionals’ concern over the increase in the number of cases of vitamin D deficiency.
The current major public health campaign is Change4Life, a cross-Government funded campaign (£90k each from DHSSC, Heritage and BETS) to encourage people, including children, to eat more healthily and increase physical activity. This is supported by a comprehensive package of programmes including:
· An All Wales Obesity Pathway which sets out a tiered approach for the prevention and treatment of obesity, from community based prevention and early intervention to specialist medical and surgical services. LHBs, working jointly with LAs and other key stakeholders, have mapped local policies, services and activity for both children and adults against four tiers of intervention and identified gaps and will be implementing local solutions, supported by national leadership.
· MEND, a community, family based programme for overweight and obese children aged between 7-13 and their families. The multi-disciplinary programme places equal emphasis on healthy eating, physical activity and behavioural change, empowering the child, building self confidence and personal development.
Smoking
We are currently considering the responses to the consultation on the draft Tobacco Control Action Plan and will launch the revised Plan in the autumn. The draft Tobacco Control Action Plan recognises the importance of preventing young people from starting to smoke, through programmes such as ASSIST, and of protecting children from the harmful effects of second-hand smoke. We are considering what action we can take to protect children from the dangers of second-hand smoke in vehicles. On 13 July, the First Minister announced that the Welsh Government will mount a renewed media campaign to tackle smoking and exposure to second-hand smoke over the next three years and the Welsh Government will consider pursuing legislative options to ban smoking in cars where children are present, if their exposure to second-hand smoke does not start to fall within the next three years.
Sexual Health and Well-being
The Welsh Government's Sexual Health and Well-being Action Plan for Wales, 2010-2015, outlines actions to improve the sexual health and wellbeing of the population, reduce inequities in relation to sexual health, and to develop a society that supports open discussion about relationships, sex, and sexuality. It has a particular focus on preventing teenage pregnancy, with £450k being invested in a new targeted intervention for those most vulnerable to teenage pregnancy. Phase 1 will target under 17s who present to services already pregnant (particularly, offering long acting reversible contraception (LARC) pre discharge from termination services or delivery units).
Healthy schools
The Welsh Network of Healthy School Schemes is a network of local schemes which work with over 99% of maintained schools in Wales to develop a whole school approach to health, focusing on 7 health topics – food and fitness; mental and emotional health and well-being; substance use and misuse; personal development and relationships; environment, safety and hygiene. An extension of the scheme to pre-school settings is in place from September 2011.
School nursing services are an essential component of a healthy school. We are implementing the revised school nursing service outlined in ‘A School Nursing Framework for Wales’. This includes developing an outcome framework; the development of a professional network to support implementation; and facilitation of appropriate training to enhance public health skills. The most recent audit of the number of school nurses in secondary schools in Wales, in March 2011, recorded 227 school nurses in post.
(iii) Improving Health Services for Children and Young People
High quality services are essential to ensure the very best health outcomes for children and young people, and the best approach in achieving these is that of a holistic, multi-agency approach.
Setting Standards
The National Service Framework (NSF) for Children, Young People and Maternity Services in Wales was published in 2005 as a long term strategy for improving the quality of services. It places children, young people and their families at the centre of service delivery by ensuring that services are designed to meet their particular needs.
We now want to build on the NSF and to adopt a more outcome-based approach to setting out the results we want for the children and young people of Wales, including their health and well being, and identify a means by which we will measure these results to capture what we want to discover about the quality and effectiveness of NHS and local government services.
Maternity Services
Following consultation, I will be launching A Strategic Vision for Maternity Services in Wales on 19 September at the Midwife - Led unit in the University Hospital of Wales, Cardiff. It sets out a programme of action at both a national and local level to deliver our vision, which is that pregnancy and birth should be a safe and positive experience that enables the mother, her partner and family to begin parenting feeling confident, capable and supported in giving their child a secure start in life. An All-Wales Implementation Group will lead and oversee this process. A debate on Maternity Services will be held on Tuesday 20 September.
Neonatal Care
Following the Welsh Government’s response to the previous Committee’s Inquiry into Neonatal Care in Wales, LHBs, through their joint work on the Welsh Health Specialised Services Committee and the Neonatal Clinical Network, have put in place an All-Wales Action Plan to implement all the service improvements identified. This Action Plan has been informed by a review of compliance against the All Wales neonatal Standards and capacity. Individual LHBs are currently developing Action Plans to drive local activity. As part of the new 12 hour neonatal transport service which began in January, a dedicated ambulance equipped to transfer sick and premature babies began operating from July in South Wales.
An All Wales Framework for Children and Young People’s Continuing Care
Assessing and providing the continuing care that disabled children need to live independent and fulfilled lives is complex and requires effective partnership working between the NHS, local government, the third sector and other agencies. The Welsh Government is developing guidance to make the needs assessment process more effective and prompt. Draft guidance is expected to issue for formal consultation this autumn.
An All Wales Children and Young People's Continence Guidance and Care Pathway
All Wales work has been undertaken to develop a more consistent approach to the supply of continence products for children and young people. That work is nearing completion and guidance is expected to issue this autumn.
Child and Adolescent Mental Health Services (CAMHS)
Improving Child and Adolescent Mental Health Services (CAMHS) in Wales remains a high priority, with the need to develop consistent services which are accessible to all young people. Within the last year, a national action plan to improve children’s mental health services has been launched. We will continue to strengthen the range of CAMHS, including access to specialist services for both older adolescents and young people.
We have made available additional funding of £6.5 million over three years to improve CAMHS services. An independent report, Fairer Care Funding, published by the Commission on Funding of Care and Support on 4 July, shows that mental health services for children and adolescents in Wales have expanded and changed for the better with faster access to treatment and an increase in specialist staff.
Targets in the Annual Quality Framework for the NHS in Wales for 2010/11 contains specific targets to improve access to child and adolescent mental health services across the age range, including 16 and 17 year olds. LHBs have already developed plans to ensure this target is met by March 2012.
Bereavement Support
As part of the central palliative care funding being made available by Welsh Government in 2011-12, £210,072 is being provided to Cruse Cymru to develop and run comprehensive support to children in Wales who are bereaved through any cause and who require additional support. Cruse is expected to work with other services for bereaved children to ensure the appropriate level of support is available consistently and equitably across Wales.
Safeguarding Children
The NHS has an obligation to work with other statutory agencies to promote the safeguarding of children in its recruitment, employment and development of staff, in organisational structures and systems as well as in direct diagnostic and supportive services in the prevention, identification and management of child abuse. The Welsh Government is currently considering and responding to the Mansel Aylward report, exploring the role and interfaces of LHBs and Public Health Wales Safeguarding children service in the light of the National Safeguarding Forum report and possible changes to Local Safeguarding Children Board (LSCB) footprints.
(iv) Care for Children and Young People affected by illness, disability, long term conditions or who have suffered physical or emotional abuse
Child Poverty
Earlier this year, we published our Child Poverty Strategy. This Strategy gives a clear account of what the Welsh Government can achieve in helping to reduce child poverty – and improve the outcomes of low income families, which will directly impact on child health. Families First is a key response to the Welsh Government’s Child Poverty Strategy. It is an innovation programme that promotes the development, by LA areas, of effective multi-agency systems and support, with a clear emphasis on prevention and early intervention for families, particularly those living in poverty.
CAFCASS Cymru
We are making progress with the review of child contact services currently available across Wales. This will be completed by December 2011. CAFCASS Cymru is also working closely with policy colleagues to consider how consistent, appropriate support can be provided to improve services to families experiencing difficulties with contact with their children following separation.
Integrated Family Support Services (IFSS)
The Welsh Government, through the Children and Families (Wales) Measure 2010, has brought forward regulations to strengthen support to vulnerable children and families through the introduction of Integrated Family Support Services (IFSS) in Wales. This service aims to support families to stay together by empowering them to take positive steps to improve their lives and is focussing initially on families where parental substance misuse coexists with concerns about the welfare of the child. The aim is to extend this service to other families with complex needs resulting from parental mental health problems or mental illness, learning disabilities and domestic violence.
The progressive phased implementation of IFSS across Wales is a key priority for the Welsh Government, building upon the clear commitment in Sustainable Social Services for Wales: A Framework for Action, for greater collaboration and integration of services.
Autistic Spectrum Disorder
It is just over three years since the Welsh Assembly Government launched the Autistic Spectrum Disorder (ASD) Strategic Action Plan for Wales, which was the first of its kind in the UK, if not the world. Since that time we have achieved a great deal.
£2 million has been made available to develop and implement actions within the ASD Strategic Action Plan for Wales, including the development of diagnostic services for children and adults and counselling services for adults; the maintenance of the existing local infrastructure including the ASD local leads; the establishment of an ASD Learning and Improvement Network; the development of an e-resource for frontline staff; the development of regional projects for children with ASD and their families; the development of regional projects for adults with Asperger Syndrome; and the appointment of a Wales Autism Employment Ambassador, on a part-time basis, and awareness raising training for Employment Services. Since 2007, £1.7m per annum has been passed to LAs via the Revenue Support grant for children with ASD.
Wheelchair Services Investment
Following the Wheelchair Review, an additional £2.2m per annum is being invested to reduce waiting times for wheelchair services, particularly for children and young people. The funding has now been allocated and is primarily being used to double the number of clinical staff across Wales. This will ensure that individuals’ needs are assessed more quickly and enable them to have the most appropriate wheelchair to suit their need. The funding is also supporting more training for health professionals, patients and their carers. We are also working with the British Red Cross to ensure a better service to those needing to borrow a wheelchair for short periods.
Service improvement work led by the National Leadership and Innovation Agency in Healthcare (NLIAH) has already introduced changes, in particular to waiting times management, improving referral processes, thereby reducing the waiting times. Clarity on referral criteria, together with improved communication, ensures clients and carers are kept better informed of the delivery time of their wheelchair.
Sexual Assault Referral Centres (SARCs)
SARCs offer victims of sexual crime an integrated service where they can receive medical care, psychological counselling, legal advice and other support, all in one place from professionally trained staff. There are six SARCs in Wales, located in Carmarthen, Colwyn Bay, Risca, Cardiff, Swansea and Merthyr Tydfil. To support SARCs work with both adults and children, the Welsh Government has provided £192,000 over two years (2010/11 and 20112/12) to ensure the provision of local SARC services.
(iv) Other Initiatives
Parental Consent for Cosmetic Piercing
Cosmetic piercing has become increasingly popular in recent years, however complications are common. We have committed to consult on whether legislation should be introduced which would require the involvement and consent of parents for cosmetic piercing procedures on a young person below a certain age. The outcome of the consultation will inform whether a Cosmetic Piercing Bill is introduced during the 2013/14 session.