Children, Young People and Families

- Presentation to NCVYS, July 2013

Eustace de Sousa, Deputy Director – Children, Young People and FamiliesIain Mallett, Head of Public Involvement and Communications ManagerLorraine I Thomas, (Interim) VCS Partnerships Lead

Public Health EnglandAbout Public Health England

•  We are a national executive agency formed in 2013 from a number of expert organisations in public health. Our status ensures we have operational autonomy and professional and scientific credibility.

•  We protect and improve the nation’s health and wellbeing, and tackle health inequalities so that the poorest and most poorly benefit most.

•  We provide a nationwide, integrated public health service, supporting people to make healthier choices. We provide expertise, information and intelligence to public health teams based in local authorities and the NHS to secure the biggest improvements in the public’s health.

2 Understanding Public Health England

Mission

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“To protect and improve the nation’s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector.”

What we do

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– work transparently, proactively providing government, local government, the NHS, MPs, industry, public health professionals and the public with evidence-based professional, scientific and delivery expertise and advice

– ensure there are effective arrangements in place nationally and locally for preparing, planning and responding to health protection concerns and emergencies, including the future impact of climate change

– support local authorities, and through them clinical commissioning groups, by providing evidence and knowledge on local health needs, alongside practical and professional advice on what to do to improve health, and by taking action nationally where it makes sense to do so

“We exist to serve the public through the public health system, a system led locally by elected members where responsibility for the public’s health sits alongside responsibility for jobs, housing and communities.”

Public Health Priorities, 2013/14

Our priorities for 2013/14

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– Sets out Public Health England’s priorities and actions for the first year of our existence

– Five outcome-focused priorities – what we want to achieve

– Two supporting priorities – how we will achieve it

– 27 key actions to take now

– The start of the conversation – a three-year corporate plan will follow

Outcome-focused priorities

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1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol

2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency

3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics

4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme

5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

Supporting priorities

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6. Promoting the development of place-based public health systems

7. Developing our own capacity and capability to provide professional, scientific and delivery expertise to our partners

Actions 2013/14

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4. Giving children and young people the best start in life

• Launch a national programme promoting healthy weight and tackling childhood obesity

• Partner the Troubled Families programme• Accelerate improvements in child health

outcomes• Partner the Early Intervention Foundation

Children, Young People and Families

are everywhere in PHE’s Priorities and Actions

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Actions 2013/14 (extracts)

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1. Reducing preventable deaths

• Accelerate efforts to promote tobacco control & reduce the prevalence of smoking

• Report on premature mortality and the Public Health Outcomes Framework

2. Reducing the burden of disease

• Improve recovery rates from drug dependency

• Improve sexual health and reduce the burden of sexually transmitted infections

• Develop a national programme on mental health in public health

Actions 2013/14 (extracts)

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3. Protecting the country’s health

• Reverse the current trends so that we reduce the rates of tuberculosis infections

• Lead the gold standards for current vaccination and screening programmes

• Develop and implement a national surveillance strategy

6. Promoting place-based public health systems

• Make the business case for promoting wellbeing, prevention and early intervention as the best approaches to improving health and wellbeing

• Partner NHS England to maximise the NHS’ impact on improving the public’s health

• Implement the public health workforce strategy and develop the PHE workforce

BehavioursOur effectiveness depends on how we behave, so we will:

consistently spend our time on what we say we care about

work together, not undermine each other

speak well of each other, in public and in private

behave well, especially when things go wrong

keep our promises, small and large

speak with candour and courage

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Place-based approach to public health

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Public health advice

Health and wellbeing boardsHealth and wellbeing boards

Local governmentLocal government CCGsCCGsPHE

centreNHSE

area team

• EPPR• Screening and immunisation• Offender public health programmes• Specialised commissioning• Primary care public health programmes

and population healthcare

NHS providers

Non-statutory

providers*People and communities

*Including voluntary and community sector

Children, Young People and Families

• Our approach

• Variation

• Examples from:

• Early Years

• Obesity Trends and Inequalities

• Alcohol and Adolescence

• How we can make a difference

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Children, Young People and Families: A Life course approachMarmot 2010, Fair Society, Healthy Lives: The Marmot Review

Children, Young People and Families

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Life course approach

Pregnancy Early Years School-aged Adolescents

Reduce numbers of still births and infant deaths

Safe transfer of Healthy Child Programme 0-5s

Settings approach – healthy schools and FE

Reaching C&YP out of school

Healthy Weight and Physical Activity, NCMP

Adolescent public health improvement framework – targeting children & young people with multiple vulnerabilities

Corporate priori

ty

Improving health outcomesHealthy weight and tackling childhood obesity

Troubled FamiliesEarly Intervention

Cross-

cutting

Reduce numbers of under 18s killed or seriously injured in road traffic collisionsPromote resilience/ improve mental health and wellbeing

Ensure children, young people & families shape, inform our work

Life

-sta

ge p

riorit

y

Variation in Health Outcomes

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  England Best England Average England Worse

Smoking in pregnancy 2.9 13.2 29.7

Preventable Infant Mortality 2.2 4.4 8.0

MMR immunisation (by age 2 years)

97.2 91.2 78.7

Killed/seriously injured in road accidents

4.4 22.1 47.9

Obese children (4-5 years) 5.8 9.5 14.5

Hospital admissions due to alcohol specific conditions

16.9 55.8 138.3

A&E attendances (0-4 years)

136.3 483.9 1,187.4

Source: Child and Maternal Health Intelligence Network, PHE, May 2013

Early Years

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Why Early Intervention Matters

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• A child’s early experience has a long lasting impact on the neurological architecture of their brain and their emotional and cognitive development

• Pregnancy and birth a key time for change – parents have an instinctive drive to protect their young and want their child to be healthy and happy and do well in life

• Evidence that effective preventive interventions in early life can produce significant cost savings and benefits in health, social care, educational achievement, economic productivity and responsible citizenship

• There is scientific consensus that origins of adult disease are often found in pregnancy and infancy

Consequences of neglect

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Bruce Perry, Child Trauma Academy

Obesity -Trends and Inequalities

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23

10.7

%

9.1%

19.0

%

15.8

%

10.4

%

8.8%

20.0

%

16.6

%

10.3

%

8.9%

20.0

%

16.5

%

10.5

%

9.2%

20.4

%

17.0

%

10.1

%

8.8%

20.6

%

17.4

%

9.9%

9.0%

20.7

%

17.7

%

Reception boys Reception girls Year 6 boys Year 6 girls

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

Prevalence of obesity by school year and sexNational Child Measurement Programme 2006/07 to 2011/12

Child obesity: BMI ≥ 95th centile of the UK90 growth reference. 95% confidence intervals are displayed on the chart

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Obesity prevalence by deprivation decileNational Child Measurement Programme 2011/12

Child obesity: BMI ≥ 95th centile of the UK90 growth reference

12.8%

14.4%15.5%

17.0%17.9%

19.7%21.0%

22.5%

23.9% 24.2%

6.2%7.2%

7.8% 7.9%8.6%

9.5% 10.0%10.8%

11.7%12.4%

0%

5%

10%

15%

20%

25%

Least deprived

Most deprived

Obe

sity

pre

vale

nce

Index of Multiple Deprivation 2010 decile

Year 6

Reception

Alcohol and Adolescence

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Alcohol use among young people in England, 2011

• 45% of pupils had drunk alcohol, a decrease from the peak of 61% in 2001

• 12% of pupils had drunk alcohol in the last week compared to 26% in 2001

• 7% of pupils said they usually drank at least once a week, compared with 20% in 2001

• Drinking alcohol in the last week is associated with age, ethnicity, and other risky behaviours (smoking, drug taking and truancy)

The Health and Social Care Information Centre 2012

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Smoking, drinking and drug useSmoking, drinking and drug use among young people in England in 2011http://www.natcen.ac.uk/

0

10

20

30

40

50

60

70

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

%

Year

Ever drank alcohol

Ever smoked

Ever taken drugs

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Substance Use Among Students in 36 European Countries ESPAD 2011

UK European Average

Alcohol use last 30 days 65% 57%

Heavy episodic drinking past 30 days

52% 39%

Public involvement and participation

29 Presentation title - edit in Header and FooterUnderstanding Public Health England29

Public involvement benefitsBenefits will include:

• Supports the delivery of PHE’s Priorities for 2013-14 and help embed the PHE Quality Framework in our work.

• Public health advice and services can be evaluated by the intended recipients i.e. the people who should benefit from them.

• Help to validate our actions and plans by providing evidence which can be both quantitative and qualitative.

• Meet the requirement for research funding bodies to have a public involvement component in proposed projects.

30 title - edit in Header and FooterUnderstanding Public Health England30

Delivering our priorities Public Involvement will enable PHE to: 

• Involve the public in the promotion of a new narrative about prevention and early intervention as well as the social determinants of health.

• Involve and work with people from ‘seldom heard’ communities so that the health needs of those on the margins and otherwise overlooked have national visibility.

• Work with partners especially in the community and voluntary sector to improve the health and wellbeing of our citizens.

31 Presentation title - edit in Header and FooterUnderstanding Public Health England31

Principles of PHE public involvement• Work with the public as partners both directly and through advocates in the voluntary

and community sector to protect and improve the public’s health and well-being.

• When necessary, coordinate public consultations and share good practice across PHE and with our health and care system partners.

• Listen to and value the contribution of the public, patients, service users, healthcare professionals, managers, scientists and colleagues from partner agencies.

• Bring clarity to the purpose of involvement and how we will take forward suggestions including explaining when we cannot do as the public ask.

• Ensure PHE involves and works with people from seldom heard and marginalised communities whenever possible, using a community development approach.

• Go to where people are instead of expecting them to come to us.

• Incorporate evaluation into the way the PHE plans and delivers its public involvement work.

• Report and provide evidence which demonstrates how public involvement contributes to service improvement and development.

32 Understanding Public Health England

Methods of involvement

33 Presentation title - edit in Header and FooterUnderstanding Public Health England33

There are a range of mechanisms for directly involving the public in PHE work. These can include (not exhaustive):

• Public PHE meetings (Board meetings other programme boards)

• Participating in national or local meetings organised by community organisations

• Subject or condition specific focus groups

• Review / citizen panels

• Online feedback and surveys

• Social media

• Through representative groups and community organisations

Ladder of participation

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– Information– Consultation– Deciding together– Acting together– Supporting community

initiatives

Understanding Public Health England34

Information Providing information to the public about new and emerging diseases such as a new

strain of pandemic influenza or providing advice on how to improve their health and

well being.

Methods include – print, broadcast and social media as well as leaflets, websites and

social marketing. PHE activities: Public relations and marketing activities

Consultation Asking the public what they think about PHE strategies, plans and policies as well as

how it responses in emergencies, for example feedback on our priorities, business

plans and equality objectives.

Methods include – special meetings, discussion groups, questionnaires, online

surveys and forums. PHE activities: People’s Panel questionnaires and discussion groups. (Level 1 and

2) See Appendix1 for definition of involvement levels.

Deciding

together

Developing ideas together with the public deciding about what improvements are

needed to the current services, priorities for change and what sort of solutions might

be appropriate for PHE to implement.

Methods include – deliberative events and community development activities

including those aimed at the hard to reach and marginalised. PHE activities: Equality Forum hosting seminars for stakeholders or running Citizen’s

Juries. (Level 2)

Acting together All the stages of deciding together but in addition would include an element of public

involvement in the implementation phase – e.g. involvement in planning, writing and

producing public health information.

Methods include – partnership building working through partnership bodies. PHE activities: Members of the People’s Panel who sit on PHE working groups and

committees. (Level 3)

Supporting

community

initiatives

A group of people who have experience of health inequality eg developing a

community-led resource to improve the health and well-being of a hard to reach

community.

Methods include – capacity building through advice, support and funding.

PHE activities: Engaging with the public through voluntary and community sectors

organisations

PHE People’s Panel• ‘People’s Panel’ - almost 1000 people across England are part of the panel

forming the largest consumer panel of its kind in the country. The People’s Panel was established as an innovative way to engage with the public about health priorities, information and services. Membership was drawn from two national random samples giving a unique and valuable insight into public health issues that the public feels are important and how they understand and respond to health information.

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Public involvement at local level

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Existing structures for local PHE to involve the public include:

• PHE has made it a priority for local centres to be active partners in their health system; this includes the voluntary and community sector. PHE national will help to support the sharing of good practice to raise awareness of local initiatives. PHE will also promote existing national initiatives. At regional and local level, the voluntary and community sector have a clear role to play as advocates, mediators and facilitators at local level and across specific community groups.

• There are opportunities to build on involvement with HealthWatch. Currently a member of the national steering group for HealthWatch England sits on the PHE Equality Forum and members have taken part in workshops to set up HealthWatch in their various local authority areas. This contributes to the assurance element of the PHE Quality framework for a ‘Public Voice’.

Understanding Public Health England36

Working in partnership with and through the Voluntary and Community Sector (VCS)

PHE will work in partnership with the VCS to achieve progress on improving the public’s health and wellbeing, and tackling inequalities.

‘We will work alongside the voluntary sector and do all we can to help get them “into the room” to co-design services that are integrated as well as, of course, delivering them. One without the other rather misses the point.

 … it is inconceivable that the VCS could not be a partner in relation to the discussions about how to make things better.

…It would take the statutory public health system 10 years to have a fraction of their impact and reach… There is an army waiting – everything from faith groups to the British Red Cross. It is stunning.’ Duncan Selbie, Chief Executive, Public Health England:

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Working in partnership with the VCSWhat we have heard so far from Sector leaders:

• an open and honest relationship with regular communication

• early involvement with a focus on action – be clear and practical about purpose, use ‘task and finish’ groups

• avoid a single approach to the Sector; adapt to organisations and purpose

• regular one to one contacts or forums for organisations across the Sector

• some saying avoid siloed engagement with the Sector but create purposeful, dynamic engagement across Sectors

• use existing forums, e.g. Strategic Partner Programme, Active Communities Development Group where possible and align engagement with other system leaders

• collaborate and share information and resources with the community – e.g. in health promotion materials and campaigns

38 Public Health England and VCSE Sector

How can we make a difference?• Use knowledge about risk and what builds resilience

• Promote evidence and learning from practice about what works

• Combine targeted help for those most at risk with universal interventions

• Take a life course and place-based approach –schools, families, and communities

• Work in partnership, taking a coordinated and collaborative approach, recognising strengths of different partners and using resources effectively

• Listen and act on what children, young people and carers tell us

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PHE Contacts

PHE’s website is www.gov.uk/phe You can follow us on Twitter @PHE_uk

See also• www.chimat.org.uk

• www.hscic.gov.uk/

• www.earlyinterventionfoundation.org.uk

If you would like to get in touch please contact

Eustace de Sousa – eustace.desousa@phe.gov.ukIain .Mallett – iain.mallett@phe.gov.ukLorraine Thomas – lorraine.thomas@phe.gov.uk.

40 Public Health England and VCSE Sector