healthy lives, brighter futures – the strategy for children and young people’s health fiona...
TRANSCRIPT
Healthy lives, brighter futures – The strategy for children and
young people’s health
Fiona SmithAdviser in Children’s & Young People’s Nursing,
Royal College of Nursing, United Kingdom
The voice of nursing in the UKThe voice of nursing in the UK
Healthy lives, brighter futures is a joint strategy
A healthy childhood is critically important
Improving children and young people’s physical and psychological health, by investing in children’s health from the early years, through childhood and
adolescence, will benefit children, families, society and the NHS.
Children and young people are healthier than ever before
Supported by medical, technological, social and economic advances
Helped by more information and support for parents and more skilled professionals
To address inequalities, current trends and public concern
The past decade has seen continued improvements
But we need to do more to become world-class
The Strategy cements standards and ambitions
The Child Health Strategy
• Reflects PSA priorities to:
– Reduce inequalities in infant mortality
– Reduce teenage pregnancy
– Increase uptake of breastfeeding and reduce obesity
– Reduce experience of bullying
– Reduce hospital admissions for children’s injuries
– Reduce preventable child deaths
– Improve services for CAMHS and disabled children
The Child Health Strategy
•Cements standards and ambitions:
– The NSF for Children Young People and Maternity Services– High Quality Care for All, NHS Next Stage Review– Every Child Matters– The Children’s Plan
and reflects the concerns people raise as:– Children and Young People– Parent and Carers– Practitioners
Four principles underpin improving users’ experience of services from birth to 19
Public sector provide healthy settings and encourage healthy choicesHealthy opportunities
The right servicesResponsive services
Extra support for those vulnerable to poorer health outcomesTargeted support
Information for mothers, fathers and carersInformed users
Continued improvement to services to support families from pregnancy onwards
World-class health outcomes
Services of the highest quality
Excellent experiences in using services
Minimise health inequalities
Support to parents to give their children a healthy start and partners to deliver change in every area
Achieve long-term aims for children and young people’s health
Pregnancy and the early years
School-age children
Young people
Children with acute and additional needs
Delivery systems transformation
The scale of the health problem
•High prevalence of risk factors compared to other European countries (e.g. births to women under 20 years of age; women smoking during pregnancy
•Risks are not distributed equally; links to deprivation and with a growing impact of economic recession
•Our rising birth rate, relatively high incidence of teenage pregnancies and rising proportion of pregnancies in older women means more risk to manage and a growing target group for health promotion.
•Increased hospital activity and preventable child deaths
The scale of the health problem
•1.1 million children with asthma in the UK (3 children in every classroom)
•Type 2 diabetes likely on the increase as a result of the increased proportion of obese children
•Disability services lack consistency across the country, with evidence of unmet need
•Significant prevalence of mental and emotional disorders with consequences for educational outcomes
Neonatal and infant mortality: key facts
Reductions in infant mortality (1970 to 2006) in England & Wales to 5 per 1,000 live births are:
• leveling off
• unevenly distributed (inequalities by region, maternal age and country of birth)
• a poor position compared to other European countries
Range of actions needed to impact on closing the gap in infant mortality, e.g.
• reducing conceptions in under-18s
• reduce overcrowding in the routine and manual socio-economic group
• reduce the rate of smoking in pregnancy
• reduce the prevalence of obesity and improve infant nutrition
• early booking and optimal pre-conception care
England’s neonatal mortality rate of 3.4 deaths per 1,000 includes wide variations, from 1.8 in Surrey and Sussex to 4.8 in South West Midlands
Long-term conditions and hospital activity: key facts
• Emergency admissions have increased over the past decade in the 0-19 age group
• Over 800, 000 emergency admissions of children and young people in England every year, with wide variations in rates at PCT level
• Long term conditions accounting for high numbers of emergency bed days are asthma, diabetes, epilepsy, cystic fibrosis and sickle cell disorders
• Children in England have one of the worst incidences of type 1 diabetes and one of the worst records of diabetic control
Long-term conditions and hospital activity: key facts
Opportunities for health gain: the example of asthma:
– over past six years, average of 27, 500 hospital admissions each year for asthma in 0-18s
– cost of treating a child with asthma exceeds adult asthma treatment cost
– the more deprived a child is, the more likely that the child will attend A&E for an asthma-related admission
– an estimated 75% of current asthma related childhood hospital attendances are avoidable
Disability: key facts •Research suggests 3 to 5.4% of under-18 population has a disability
•Outreach work is extending into community settings: family homes; schools; extended schools; children’s centres
•Large variation across PCTs in support systems available to families to improve quality of life for families
•Parents of 39% of children aged over 5 tell us that their child has unmet leisure needs
Mental health: key facts
• 1 in 10 children has a mental disorder
• 4% of children have an emotional disorder
• Children with emotional disorders were more than twice as likely as other children to have had unauthorised absence from school (21% compared with 9%)
• The UK ranked bottom amongst developed counties (OECD) for subjective wellbeing indicator
Prevelence of mental disorder in children and young people
0% 5% 10% 15% 20% 25%
Two-parent family
Families whereboth parents work
One-parent family
Neither parentsworking
The prevalence of mental disorders is greater among children and young people in certain family-types:
Sexual Health: key facts
• Teen infection almost doubled during 90s
• The sexual health of adolescents in the UK is poor. It is likely that an increase in risky sexual behaviour has contributed to sexual health outcomes such as STIs and unwanted pregnancy among young people.
Alcohol consumption is rising
.. And Britain leads the wayHealth Behaviour of School Age Children
SmokingHealth Behaviour of School Age Children
Sexual Health
Teenage pregnancy rates are falling – but not fast enough
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Projection of trend
Trajectory required to meet target
Prevalence of obese children by parental obesity
Actions: School-age children + Young People
• Healthy child programme for school-age children to be developed
• National Healthy Schools Programme to be strengthened
• PE and sport in schools to be increased (Olympics)
Actions: School-age children + Young People
• Extending free school meals to more children
• Personal, Social, Health and Economic education to be improved and statutory
• ‘You’re Welcome’ standards to be rolled out
• Increase young people’s knowledge of effective contraceptive services in a range of settings
Looking back
Why was the school medical service founded in the UK?
Poor health of recruits for the 1st World war
Workforce calculations
1 school nurse was needed for every 2,500 children
The school nurse:
• is a specialist practitioner working across education and health
• provides the link between school, home and the community
• needs to have advanced and specialist knowledge and skills to meet the needs of children and their families
The role of the school nurse:
• health promoter
• health educator
• works in collaboration with others such as teachers, youth workers and counsellors
•provides access to confidential advice and guidance on a range of issues
• enables and empowers young people to make healthy life choices which affect them throughout their lives
The school nurse:
• delivers on health priorities by providing information about areas such as good nutrition, exercise, smoking, mental health, drugs and sexual health
• identifies vulnerable children and young people, implementing early interventions and referring to specialists and other sources of support when required
Health Priorities
• Accidents• alcohol and drugs• smoking cessation• mental health• obesity, nutrition and
physical activity• sexual health and
teenage pregnancy.• safeguarding and
promoting children and young people’s welfare
The role of the school nurse:
• shaping and influencing policies across the school environment to tackle issues such as bullying, the provision of safe drinking water and clean toilet facilities
• drop-in advice sessions enable direct access to health information from a nurse
They used to check for nits, but 60 years after the NHS was founded school nurses have a very different role……..
http://news.bbc.co.uk/1/hi/england/7493562.stm
School Nurses today ………..
Children and young people are a high priority
•Challenges persist
– e.g. Infant mortality, teenage pregnancy, hospitalisations, LTC management, disability, mental health
•New challenges arising
– e.g. Obesity, autism, service redesign, NHS reform
•Unacceptable variations in risks and outcomes
•Children’s early experiences can have lifelong consequences: How do we ensure prevention early intervention and support
•No room for complacency: The Child Health Strategy is the vehicle for making it happen
Investing in school nursing - long term outcomes
School nursing is a universally accessible service, non stigmatising and acceptable to most families and school communities
Investment in school health services has the potential to make a considerable difference to health of the future population
The RCN position
• The RCN recognises the importance of school nursing
• The RCN school nurse campaign calls for a need to invest in school nursing services
• The RCN wants to see a qualified nurse in every school
