A good start in life

1. A good start in life

2. Breastfeeding: Trends in initiation rates Reading West Berkshire Wokingham Lowest rates in Barkham, Shinfield North, Hawkedon, Arborfield, Bulmershe & Whitegates wards Lowest rates in Speen, Greenham, Thatcham Central, Northcroft & Hungerford wards Lowest rates in Barkham, Shinfield North,Hawkedon, Arborfield, Bulmershe & Whitegates wards • Key Issues & gaps • Lowest initiation rates in teenage mothers • Yet to achieve robust data coverage levels of 95% for 6-8 weeks • Drop off rate from initiation to 6-8 weeks • Still higher than BW would like at 29% • Still areas where little improvement seen • In progress towards BFI accreditation • Commissioning recommendations • Continue implementation of UNICEF Baby Friendly Initiative (BFI) • Continue implementation of the breastfeeding peer support programme in deprived Reading wards • Invest in sustainable data systems to ensure adequate 6-8 weeks initiation coverage data for valid prevalence estimates.

3. Breastfeeding: 6-8wk prevalence * Data is not recorded if the coverage was below the set target. Each quarter in 2009/10 Berkshire West coverage data was below the target for validity

4. Oral Health West Berkshire A mean dmft of 0.6 Wokingham A mean dmft of 1.1 Reading A mean dmft of 2.7 • Key issues and gaps • Inequalities in access to dental services. • Proportion of child population accessing NHS dentistry slightly lower than national average. • Considerable variation by age and LA of children accessing an NHS dentist. • Commissioning recommendations • Consult with local communities to inform commissioning and identify barriers preventing access to children from deprived communities. • Provide a range of models of care to meet the needs of a diverse population. • Social marketing to encourage preventative dental attendance • Co-locate dental services with other services where possible

5. Avoidable Injury • Leading cause of death and illness among children and young people • Strong correlation between socioeconomic inequalities and child injury • Berkshire CDOP (2009/10) reviewed 82% of deaths recorded of which 9% were considered preventable and a further 7% potentially preventable • Modal age group was the 10-17yrs group (39%), mainly due to suicide and deliberate self harm • The three Berkshire West Authorities are ranked among the low risk areas for child death due to road accidents • Key issues and gaps • Extent of unintentional injury in the UK and locally hard to capture due to significant gaps in national data collection • A local needs assessment of avoidable injury has yet to be undertaken in Berkshire West • Lack of capacity within Health & UAs to undertake and co-ordinate a targeted and strategic programme of work to reduce and prevent avoidable injury to children and young people

6. Infant Mortality • Reading • Infant mortality rates significantly higher in Reading cf. rest of BW, national & regional rates. • In 2006/08 Infant Mortality Rate was 6.8 per 1000 live births • West Berkshire • In 2006/08 the Infant Mortality Rate was 4.2 per 1000 live births • Similar to the national and regional rates • Wokingham • In 2006/08 the Infant Mortality Rate was 3.2 per 1000 live births • Lower than the national and regional rates • Key issues and gaps • Significant levels of child poverty remain, particularly in Reading • Breastfeeding rates remain lower in deprived areas • Rates of maternal obesity are increasing • Continuing high rates of teenage pregnancy in Reading • Disparities in the uptake of immunisations • Commissioning recommendations • Work underway to tackle the underlying determinants of infant mortality. Further work is needed in: • Reducing number of children in relative low income households • Ensure that the evidence based interventions to prevent SUDI are widely understood in target groups • Implementation of recommendations from NHS Berks West Maternity Review 2010

7. Child Protection • Reading • No. of CP enquiries risen from 187 to 510 in last 4 yrs • No. of children subject to CP plan risen from 91 to 156 in last 4yrs • Domestic violence & parental drug/alcohol problems commonest reasons • West Berkshire • No. of CP enquiries risen from 98 to 213 in last 4 yrs • No. of children subject to CP plan risen from 31 to 66 in last 4yrs • Domestic violence & parental mental health issues commonest reasons Wokingham • Key issues and gaps • Increase in CP cases places pressure on staffing resources in Children’s services and other agencies • Designated & Named Doctor vacancies in West Berks and Reading • Lack of proximity of location for forensic examinations (Slough) • Lack of CAMHS Capacity – due to vacancy, waiting times still high • Commissioning recommendations • Improved interface between children’s and adult services (Think Family) • Develop interventions that aim to reduce domestic abuse

8. Alcohol and substance misuse • Reading • Drug misuse admissions in YP higher than SE average • Alcohol admissions in <18s in 2008/09 31.9 per 100,000 • In 2009/10 58 YP entered Tier 3 substance misuse services • West Berkshire • Drug misuse admissions in YP lower than SE average • Alcohol admissions in <18s in 2008/09 28.7 per 100,000 • In 2009/10 50 YP entered Tier 3 substance misuse services • Wokingham • Drug misuse admissions in YP lower than SE average • Alcohol admissions in <18s in 2008/09 23.5 per 100,000 • In 2009/10 38 YP entered Tier 3 substance misuse services • Key issues and gaps • Poor local data on drug & alcohol use by YP in BW • TellUS surveys not capturing YP not attending school/education – group most at risk • The Healthy schools programme in West Berks & Reading no longer commissioned by the LA – schools potentially unsupported in delivering curriculum • Commissioning recommendations • Earlier identification of YP engaged in ‘risky’ drinking e.g. YP attending A&E • Capture alcohol-related A&E attendance & admissions for YP • Undertake detailed local needs assessment • Ensure identification, assessment & referral pathway for substance misuse is reflected in Children’s Trust pathway mapping process • Support for schools around drugs and alcohol education may be required

9. Early Intervention • Combination of: • Early years development (including language & communication skills) • Parenting support • Prioritising resources on children < 5 yrs (including in the womb) • Offer potential for greatest impact on long term health outcomes and inequalities • - Marmot review • “Perhaps the single most important cultural shift that is needed from the NHS is to invest in the development of children in their early years…these early years are absolutely central to the developmental fate of a child”. • - Kennedy Report 2010

10. Early intervention - maternity • Reading • Age profile of mothers similar to national profile • 42% of births are to women born outside the UK (much higher than UK average) • West Berkshire • Mothers tend to be older than national average • Wokingham • Mothers significantly older than national average • Good progress made: • Fewer women smoking in pregnancy • Breast feeding initiation increasing • Key issues and gaps • Early access to antenatal care especially teenagers, older mothers, BME groups • High proportion of Caesarean sections and instrumental deliveries • Commissioning recommendations • Increase availability of midwife-led care • Review maternity provision in primary care • Ensure comprehensive assessment and management of risk: rising maternal obesity; mental health problems; social risk; Hep B and BCG vaccination; smoking and breast feeding.