Analysis

Charity highlights unhealthy postcodes for under fives

A leading children’s charity report has highlighted startling differences in health outcomes among under fives according to where they live in England. The report has been released as the commissioning of public health for children in this age group, including health visiting and family nurse partnerships, is transferred this month to local authorities.

A leading children’s charity report has highlighted startling differences in health outcomes among under fives according to where they live in England. The report has been released as the commissioning of public health for children in this age group, including health visiting and family nurse partnerships, is transferred this month to local authorities.

The National Children’s Bureau’s report, Poor Beginnings, states that children in poorer areas are more prone to obesity, tooth decay, accidental injuries and lower educational development. The charity says that the government has a pivotal role to play in supporting the development of under fives. The report also calls for more research into local strategies and programmes to assess why some areas ‘buck the trend’ with better than expected results despite high levels of deprivation.

In London there were lower numbers of hospital admissions due to injury compared with other regions and high rates of good development in school preparation, but also the highest rate of obesity and elevated levels of tooth decay.

Injuries

The report covers key indicators in the government’s Public Health Outcomes Framework along with data compiled by Public Health England’s National Child and Maternal Health Intelligence Network. It shows that, in 2013-14, more than 48,000 children under five were admitted to hospital due to intentional and accidental injuries.

Delegates at the RCN’s annual conference in Bournemouth this year backed a resolution overwhelmingly calling on RCN council to lobby all UK governments to invest in young people and end child health inequalities.

RCN professional lead for children and young people’s nursing Fiona Smith says the discussion highlighted the strength of feeling among nurses about this issue.

Greater investment

‘It would be interesting to see if the investment in health visiting has indeed had an impact on indicators such as obesity. Clearly, there has to be greater investment and more education places for children’s nursing.

‘As the report sets out, it is important to remember that there are marked variations in outcomes, not just in the acute sector, but across primary care. We must watch what the government does about funding.’

Some of these variations in local authority outcomes are:

  • Obesity 5.5% of children in Richmond upon Thames are obese compared with 14.2% in Barking and Dagenham 18 miles away.
  • Tooth decay 9.5% of children had tooth decay in West Sussex compared with 51% in Leicester.
  • Injury with hospital admission 67.6 per 10,000 in Westminster compared with 316.4 per 10,000 on the Isle of Wight.
  • Development and school readiness 75.3% in Lewisham, which has areas of deprivation, compared with 41.3% in Leicester.

(National Children’s Bureau 2015)

Savings

In June the chancellor announced £3 billion savings to be made across government in 2015-16 to reduce public debt including £200 million from the public health grant.

The Department of Health (DH) has begun a consultation on local authority public health ‘in-year savings’ and insists that the government will work ‘to give all children the best start in life’.

A spokesman adds: ‘For example, we have increased the numbers of midwives and health visitors and later this year our childhood obesity strategy will outline how we will help children lead healthier lives.

Variations

‘The variations in this report underline the need for devolving public health spending to local areas who know the issues which affect their population.’

The DH says the transfer to local authorities will promote a ‘sustainable and locally-tailored service’ for under fives. It says that the government has consulted on the best way of delivering any savings that need to be made and is now ‘considering the responses’.

A report published in the Archives of Disease in Childhood showed that twice as many under fives die in the UK compared to Sweden, which also has free public health care.

More responsibility

In the same month, 89% of 751 health visitors across England who took part in a survey commissioned by the Community Practitioners’ and Health Visitors’ Association said their workloads have involved taking more responsibility for children and families over the last year.

A total of 37% of the respondents said the chances of a child death in their NHS trust or board was ‘somewhat likely’ - with 10% stating it was ‘very likely’.

Unite professional officer Dave Munday says that, despite the rise in numbers, health visitors are not reporting the benefits in frontline services, because the new numbers only corrected previous cuts.

Negative impact

‘Some local authorities may be able to do a good job following the changeover, but any cuts to the public health budget will have a negative impact on children’s nursing teams and families.’

Institute of Health Visiting director Cheryll Adams explains: ‘The risk in public health being commissioned by local authorities is that these commissioners may not understand the importance of health visiting and children’s nurses. ‘If health professionals cannot explain their input, there is a danger of decommissioning rather than seeing the numbers of health visitors and children’s nurses rise.’

Birmingham Children’s Hospital NHS Foundation Trust chief nursing officer and Association of Chief Children’s Nurses chair Michelle McLoughlin says that children’s health has been viewed as the responsibility of health visitors for too long.

‘We see children and families in hospitals too. This is about finding ways to reduce inequalities whenever we can. Talking with young mothers on neonatal wards is an example. In our trust we try to be proactive in health promotion and have these conversations consistently.’

More information

Poor Beginnings report

 

 

 

 

 

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