Agenda item

To discuss one of the three Board priorities – Best Start in Life, with a focus on effective collaboration to address the issues that improve school readiness, including the importance of speech and language.

Ruksana Sardar-Akram, Interim Public Health Consultant, Lancashire County Council presented the outline strategy for achieving the best start in life for children and families across Lancashire.

 

The Board noted that comparing local indicators with England averages, the health and wellbeing of children in Lancashire is generally worse than England.  Therefore, setting the foundations for health and wellbeing during pregnancy and in the early years is crucial to ensure that every child in Lancashire is given the best start in life possible.  To do this, a collaborative approach is required alongside plans to target inequalities, especially in the first 1001 critical days from conception.  Further details of the outline strategy for achieving this for children and families in Lancashire and the next steps for best start in Lancashire were set out at Appendix 'A' attached to the agenda.

 

It was highlighted to the Board that the best start in life national review identified six actions:

 

Ensuring families have access to the services they need:

 

i)  Seamless support for families: a coherent joined up Start for Life offer available to all families.

ii)  A welcome hub for families: Family Hubs as a place for families to access Start for Life services.

iii)  The information families need when they need it: designing digital, virtual and telephone offers around the needs of the family.

 

Ensuring the Start for Life system is working together to give families the support they need:

 

iv)  An empowered Start for Life workforce: developing a modern skills workforce to meet the changing needs of families.

v)  Continually improving the Start for Life officer: improving data, evaluation, outcomes and proportionate inspection.

vi)  Leadership for change: ensuring local and national accountability and building the economic case.

 

The Board were informed that the data on children and young people in Lancashire identifies that:

 

·  Inequalities exist, with many child indicators in Lancashire worse than England.

·  Some children have poorer health outcomes than others.

·  Inequalities exist at district level and in Lancashire's most deprived areas.

·  There is a need to address the wider determinants such as child poverty, educational attainment, school readiness is key.

·  School readiness in Lancashire is below England, with a reduction in girls being school ready shown in the latest data.

 

Children achieving a good level of development at the end of reception is significantly worse than the England average.  Lancashire is 69.2% compared to 71.8% in England in 2018/19.

 

In terms of best start in life and 1001 critical days, support starts very early on from conception, pregnancy and birth and targeting those families early.

 

Further local variation data that was included in Appendix 'A' in relation to:

 

·  Pregnancy and infancy

·  School age health

·  Poverty and Looked After Children

·  School Readiness

 

It was outlined to the Board, as to why school readiness has been chosen as a key priority outcome for best start.  It was noted that uptake of the 2-year-old nursery offer varies in each district with Lancaster (95%) with the best take up and Hyndburn (76.4%) the lowest take up (Appendix A).

 

School readiness starts at birth with the support of parents and care givers, when young children acquire the social and emotional skills, knowledge and attitudes necessary for success in school and life. School readiness at age five has a strong impact on future educational attainment and life chances.  Children who do not achieve a good level of development aged 5 years struggle with:

 

·  Social skills

·  Reading

·  Maths

·  Physical skills

 

These can impact on outcomes for children in later life:

 

·  Educational outcomes

·  Crime

·  Health

·  Death

 

 

 

 

Michelle Lee (HCRG Care Group) reported to the Board that the mandated services that are commissioned by Lancashire County Council have seen an increase in need following the pandemic.  It was noted that there were two specialist perinatal and infant mental health visitors who support the generic health visitors and work with any parents or carers who are identified as having greater need, when a bespoke programme is offered.

 

The Board noted that the Best Start in Life Strategy includes the following elements:

 

·  Early Years Strategy

·  Infant Mortality Action Plan

·  Lancashire Children and Young Peoples Outcomes Framework

 

Michelle Lee (HCRG Care Group) spoke about the Healthy Child Programme and the Board noted that health visitors provide five mandated health visits during the early period of a child's life.  In addition, there has been recent investment in the Maternal Early Childhood Sustained Home Visiting Service (MESCH) which is an intensive health visiting programme with structured extra visits when additional need is identified.  All staff will be trained in this by the end of June and staff who are trained are now enrolling families onto the programme.

 

Another programme being delivered is the Empowering Parents Empowering Communities (EPEC) Parenting Programme where volunteers within communities are trained and supported to deliver parenting peer support to other parents within their community.  This has been piloted in Burnley and was evaluated well and it is planned to roll this out across the Lancashire footprint.

 

It was noted that there is a vast offer of support services available in Lancashire and it is paramount that these resources are used in addressing the issues.

 

The Board were also informed that there was currently a 52-week waiting list for Speech and Language Therapy.  Early intervention support is being put in place, to help alleviate some of this pressure at an earlier stage.

 

Following the presentation, the following comments/issues were raised:

 

·  It was queried whether waiting lists were due to staffing capacity, and if so, how can communities be better engaged and supported with this.  It was noted that there was a staffing issue nationally with recruitment and retention of staff.  The Board were also informed of a developing programme "50 things to do in Lancashire" which is around engaging with communities and looking at what they want and building on that, including having Community Champions/Advocates involved.  Michelle Lee (HCRG Care Group) informed the Board that services are being delivered in the three localities and embedded in communities. It is felt that this has helped with recruitment – with eight new Health Visitors commencing in May 2022.  There is also a "grow your own" scheme where staff nurses are being encouraged to join the team and then undertake specialist qualifications.  It was noted that the service was in a better position with regards staffing than it was 12 months ago.

·  It was felt that peer support works really well, and this should be encouraged throughout the services and also utilise the roles of volunteers and highlights the need to recruit more to help and support.

·  Need to ensure that services collaborate.

·  Virtual engagement with young mums, has been working well through sessions that were set up throughout the COVID-19 pandemic, working alongside specialist services, such as Midwifery, Early Years, Speech and Language Services. These will be continuing at the request of parents who have attended.

·  Discussions are taking place on how the wider determinants of health influence child health outcomes, and how these areas of work are taken forward.  It is important to share good practice, in making the best start in life a priority and leveraging the role of District Councils, Voluntary Community and Faith Sectors, including Housing Associations, local nurseries and employers. Family hubs are also a way of bringing key services together.

·  It was noted that during the COVID-19 pandemic most District Councils in Lancashire had increased community engagement and this continues post-pandemic.

·  The 2-year-old take up of nursery placements was discussed and why uptake varied so widely across the county. Ruksana Sardar-Akram was requested to provide further analysis to help communicate the opportunities for take-up of nursery placements.  It was noted that data was the underpinning theme and how that data was used to improve services within the communities and understand what is happening within them.

 

Resolved:  That the Health and Wellbeing Board:

 

(i)  Endorsed the strategic development of the Best Start in Life Programme.

(ii)  Committed to the collaborative approach with the emerging Integrated Care System to support cross organisational leadership and delivery responsibilities.

(iii)  Supported the unifying outcome for best start in life as school readiness.

(iv)  Would receive future updates as the programme of work develops further, in particular data outcomes.

(v)  Requested that Ruksana Sardar-Akram provide further analysis on the 2-year-old take up of nursery placements to enable sharing of good practice as well as communications and opportunities in these settings highlighted.