· Annex 4

Partnership working with Health

 

Current programme of work

 

Further to the Child Health Strategy Healthy Lives, Brighter Futures (February 2009), which set out a joint DCSF/DH vision for prevention, early intervention and effective specialist support from 0-19, work is underway on service delivery programmes to ensure better support in pregnancy and the early years of life. There are also strong links to wider system-led transformation like commissioning support.

The work falls broadly into:

a. Service delivery programmes being delivered via children's centres and other settings.

b. Action on specific health outcomes which children's centres are helping to support.

 

a. Specific delivery programmes delivered through settings including children's centres

(i) The Healthy Child Programme (pregnancy to 5 years)

The Healthy Child Programme (HCP) is the evidenced-based child public health programme offered to all families from pregnancy to 5 years of age. The HCP, led by Health Visitors, offers a core programme of screening tests, immunisation, developmental reviews, support and guidance to assist with parenting and healthy choices. The updated programme was launched in March 2008. Children's centres offer significant opportunities for improving children's health and are a key vehicle, along with general practice, for delivering the Healthy Child Programme. The Child Health Strategy committed to a named health visitor for each children's centre (see below). Last summer, the DCSF wrote to all children's centres about the (then named) Child Health Promotion Programme, encouraging them to promote it.

(ii) Action on Health Visiting Programme

Health Visitors are key to delivery of the Healthy Child Programme, with clear responsibilities and support to lead the programme, and a key role to play in children's centres. The way services are organised now means that health visitors are more likely to be working in teams in which support for families is available in more innovative ways.

The Action on Health Visiting Programme, announced by Alan Johnson in response to Lord Laming's report on safeguarding children, is a joint venture between DH, CPHVA Unite and other key stakeholders. The Action on Health Visiting Programme has addressed a number of the issue set out in a joint DH CPHVA statement. It has defined the roles of health visitors in the context of the new range of children and family services (including Sure Start Children's Centres - distilling clear messages about how they work with health visitors and what they can expect), restated their potential impact in promoting health and wellbeing and addressing inequalities and set out the evidence base for practice. It has been developed with the CPHVA, the profession and NHS leads and includes their roles with vulnerable children and in child protection. The AHVP sets out steps to improve recruitment retention, career pathways and increase commissions to train new health visitors.

 

b. Specific health outcomes which children's centres can help achieve

(i) Infant mortality

Children's centres working closely with colleagues in health have a key role to play in helping address the national health inequalities target (underpinning PSA 18), starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between the routine and manual group and the population as a whole. The infant mortality national support team (NST) offers support and guidance for local authorities, NHS organisations and other partners in promoting local action on improving infant and maternal health and reducing infant mortality. By providing health services in a community setting with a wider set of facilities, children's centres are able to reach and support groups who may otherwise feel uncomfortable raising some health concerns. Centres can also provide a co-ordinated approach to a wide-range of relevant issues, offering support to teenage mums, and on topics including immunisation, nutritional support, smoking cessation and breast-feeding.

The Marmot Review on Health Inequalities, due to report in early 2010, will also examine this area.

(ii) Breastfeeding continuation at 6 weeks

Children's centres are playing a critical role in supporting the delivery of local breastfeeding programmes, offering supports to new mums through a range of methods including peer support groups, helplines, breast-feeding classes and dedicated breastfeeding suites and baby massage. Work to develop Breastfeeding Commissioning Guidance contains clear messages about the role of children's centres. The Department of Health is also providing easily accessible advice through a range of promotional materials, a national helpline and DVD, as well as investing £7m to promote breastfeeding via PCTs, supported by regional and local structures. The progress report on the obesity strategy (Healthy Weight, Healthy Lives: One Year On) also committed Government to invest a further £2m in 2009/10 to extend the Baby Friendly Initiative on promoting breastfeeding to local areas with substantial numbers of non-breastfeeding mothers.

Healt
(iii) Change4Life and 0-5 childhood obesity

 

Action through children's centres around breastfeeding, effective weaning, appropriate physical activity and parenting behaviour and skills are contributing to reducing obesity. DCSF is also funding the "Henry project" (Health, Exercise, Nutrition for the Really Young), run by the Royal College of Paediatrics and Child Health (RCPCH). HENRY provides training and support enabling health professionals and community practitioners to work more effectively with parents and carers of babies and pre-school children to support them tackling childhood obesity.

Start4Life is a sub brand of the the "umbrella" Change4Life government anti-obesity campaign.  It works with young families through the Early Years Workforce, including children's centres, to promote the importance of diet during breastfeeding and weaning.  We are providing early years settings with a toolkit on healthy eating and active play as part of this. DCSF is also working with DH on Let's Get Cooking to pilot 20 training events in centres across England in autumn 2009.  Let's Get Cooking is a nationally available programme that offers training and support, to enable children and adults to gain skills and confidence to cook healthy food and enjoy cooking. 

Annex 5

Findings from evaluation/research studies

 

The National Evaluation of Sure Start

 

1. In March 2007 the National Evaluation of Sure Start reported on the impact of Sure Start Local Programmes in 'The Impact of Sure Start Local Programmes on 3 Year Olds and Their Families' . This research compared 14 child and family outcomes in Sure Start areas to a control group. Of the 14 outcomes, seven showed a significant positive difference for Sure Start areas, although care is warranted with two where timing effects in the methodology cannot be ruled out. The seven outcomes were: better child positive social behaviour; better child independence; improved parental risk index; better home learning environment and total service use. The two outcomes possibly a result of timing effects were: increased child immunisations and reduced child accidents. The remaining seven outcomes showed no significant differences in Sure Start areas.

 

2. Crucially, in describing a positive "Sure Start effect", the researchers found this was demonstrated across all population sub groups (eg teenage parents, workless households, ethnic minority families), and unlike the previous impact study there were no negative effects. The report findings are very positive and the benefits in terms of parents and child development are desirable effects that are likely to lead to better long term outcomes for children. In particular, there is sound evidence to suggest that higher child independence and higher home learning environment are likely to lead to better long term outcomes both intellectually and socially for children.

 

3. Work is in progress on the next phase of the NESS longitudinal impact study, considering the impact on five year olds and their families, and this should be published in the spring of 2010.

 

TNS Survey of Parents

 

4. In February 2009 the Department published research undertaken by TNS, 'Sure Start Children's Centres Survey of Parents'. 1,496 parents and carers of children aged under five years and expectant mums and fathers, and new parents in 120 areas which had had a centre for over two years, were interviewed to determine their awareness, use and satisfaction with children's centres. The report found:

· strong evidence that centres were reaching out to all sections of the community. "The profile of centre users very closely matches the profile of respondents overall, and there is no evidence that any sub-groups within the community are monopolising the centres. Equally, the results suggest that no sub-groups are being excluded from or failing to access the centres.", Those in social demographic AB composed 12% of the local population but 14% of centre users, whereas those in DE were 50% of the population but 48% of centre users.

· overall awareness of children's centres was high - 78% of all respondents knew about their local centre and 74% were familiar with the term 'children's centre'.

· use of the local centres was widespread - nearly half (45%) of all respondents had ever used or attended their local centre. In particular, "...a substantial proportion of users were making use of the integrated services that these centres offer. "

· for most users the experience of using a centre was very positive. Levels of satisfaction were very high with 92% of all users saying they were satisfied (68% were very satisfied). "These findings suggest that most users of the centres were happy with the services that they have used and that centres were providing a good service to local families."

 

5. In conclusion, "Overall the findings from the survey are positive and suggest that those children's centres which were designated by March 2006 are servicing the communities they were established for."