Transcript DH SoS commissioned work on health

Moving from
Fragmentation to Integration
Setting The National Scene
Karen Turner, Deputy Director, Children, Families and
Health Inequalities
Department of Health
Current facts and figures
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Mortality in Childhood (0 - 14)
UK compared to European 12
Under 18 conception
rate
•
Overall conception rate in under 18s in England in 2010 was 35.4 per 1000
women in this age group.
•
The conception rate among under 18s has declined from 40.6 per 1000 women
in 2006. Over the same period the overall conception rate amongst all women
has increased from 78.5 to 82.5 per 1000 women in all age groups.
•
Highest rate of under-18 conception is in the North-East (44.3 per 1000 women )
and lowest in the South-East (28.3 per 1000 women).
•
Under-16 conception has remained relatively stable from 2006 to 2009, although
it did decline in 2010.
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Substance abuse
•
•
•
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In 2011, around one in six (17%) pupils
reported ever having taken drugs compared
to 29% in a previous survey in 2001.
12% of pupils reported having taken drugs in
the last year in 2011, and this has declined
steadily from 20% in 2001.
Drug use in the last year was reported by
similar proportions of boys and girls.
Drug use in the last year increased with age:
3% of 11 year olds reported taking drugs in
the last year, and this increased to 23%
amongst 15 year olds.
Early drug use was more likely to be volatile
substances in younger pupils while those
aged 14-15 reported taking cannabis as the
first drug they tried.
Took drugs in the last month, last
year and ever: 2001-2011
Ever taken drugs
Taken drugs in the last year
Taken drugs in the last month
35
30
25
Percent
•
20
15
10
5
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: Smoking, drinking and drug use among
young people in England in 2011, The Health and
Social Care Information Centre
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Smoking prevalence at 15
years
Smoking is the primary cause of
preventable morbidity and premature
death. There is a large body of
evidence showing that smoking
behaviour in early adulthood affects
health behaviours later in life.
Proportion of 15 year olds who were regular
smokers, England
30
Overall
Boys
Girls
20
Percent
•
10
•
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The Tobacco Control Plan sets out the
Government's aim to reduce the
prevalence of smoking among both
adults and children and includes a
national ambition to reduce rates of
regular smoking among 15 year olds in
England to 12 per cent or less by the
end of 2015.
•
The indicator shows the number of
persons aged 15 who are self-reported
smokers as a proportion of the total
number of respondents (with valid
recorded smoking status) aged 15
•
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Between 2001 and 2011, the
proportion of pupils aged 15 who
report that they are regular
smokers fell from 22% to 11%
(Regular smokers are defined as
usually smoking at least one
cigarette per week).
In 2011 there was no difference in
smoking between boys and girls.
Previously girls reported smoking
more than boys.
Source: Smoking, drinking and drug use among young people in England in 2011, The Health and Social Care
Information Centre
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Mental health
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One in ten children aged 5 – 16 years has a clinically diagnosable mental health
problem.
•
Half of those with lifetime mental health problems first experience symptoms by the
age of 14, and three quarters before their mid-20s.
•
As part of the ONS wellbeing programme, a children and young people’s wellbeing
project has been set up to ensure that the Measuring National Well-being
Programme covers measures of children and young people’s well-being.
•
Self-harming in young people is not uncommon (10-13% of 15 – 16 year olds have
self harmed).
•
Some children are significantly more likely to experience mental health problems
than others – e.g. those with disabilities, LAC, and those living in families with
complex and multiple problems.
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Mental health
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There is a 49-fold variation across
PCTs in rate of inpatient admissions for
mental health disorders per 100,000
population aged 0-17 years, where
length of stay was >3 days.
Rate ranges from 3.4 to 166.1
admissions across PCTs in England
No statistical correlation between
admission rates and deprivation:. In
other words the level of deprivation
does not have a significant impact on
the rate of admissions. This result is
borne out by high rates of admission in
South West, South Central and South
East Coast SHA regions.
London
Rate of inpatient admissions >3 days’ duration in
children per 100,000 population aged 0–17 years
for mental health disorders by PCT
Directly standardised rate 2007/08–2009/10.
The highest rates are highlighted in dark blue,
lowest rates in light blue
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Hospital inpatient emergency
admissions for intentional self-harm
among 13-18s
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In 2010/2011, the number of
admissions for those aged 13-18 years
was 17,000. This is a rate of 45 per
10,000 population aged 13-18 years.
Hospital emergency admissions rates
for intentional self-harm among 13-18
year-olds increased by 16.9 per cent
from 2006/07 to 2010/11.
Among 13-18s, females are at least
three times more likely to be admitted
for self-harm than males.
Source: Hospital Episode Statistics (HES)
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How will Boards really make a difference
to Health and Wellbeing?
• Collective responsibility for shared leadership
• Executive decision makers;
• Engaging the public; but also other key
stakeholders
• Aligning plans and resources
• Shared priorities and therefore shared outcomes
JSNA and joint health and wellbeing
strategies; the vehicle for shared
leadership
What services do we need to commission (or
de-commission), provide and shape, both
separately and jointly? –
So what are our priorities for collective
action, and how will we achieve them
together? – JHWS
EXPLICIT
LINK
So what does that mean they need, now and in the future
and what assets do we have? – a narrative on the
evidence – JSNA
What does our population & place look like? –
evidence and collective insight
HEALTH & WELLBEING
BOARD
The ambitions behind the health
reforms for children and young
people
• To move to a system where:
– Children, young people and their families are always involved in
decisions about their care.
– Where there is informed, expert, clinical /professional knowledge
underpinning the commissioning of integrated services across
primary, secondary and tertiary care, social care and wider
services.
– Where there is a strong focus on reducing health inequalities.
– Where the focus on promoting good health is of equal importance
to caring for those who are ill.
– Where the use of evidenced based treatment is adopted across
the life course.
DH SoS commissioned work on health outcomes for
children and young people: Independent Forum
reported in July on
• Forum reported in July 2012, recommendations
included –
– 9 new indicators for the Public Health Outcomes
Framework and changes to other indicators.
– 5 new indicators for the NHS Outcomes Framework
and changes to other indicators.
– A number aimed at organisations within the health
system, e.g. NHS CB, PHE, the MHRA, NICE, CQC,
Monitor, on the contribution that they need to make
in order that improved outcomes can be delivered
NHS Outcomes Framework
1.
2.
3.
4.
Proposed New Indicators:
Integrated care – developing a new composite measure.
Effective transition from children’s to adult services.
Age-appropriate services – with particular reference to teenagers.
Time from first NHS presentation to diagnosis or start of treatment
A range of other ‘stretch’ indicators, for example:
• By 2013/14, DH and the NHS CB should incorporate the views of
children and young people into existing national patient surveys in
all care settings.
Public Health Outcomes
Framework
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Proposed New Indicators across sectors
Number of children and young people living in
decent housing.
Educational attainment and progress for all
children and young people with LTCs.
Proportion of children who experience bullying.
Proportion of children and young people with
mental health problems who experience stigma
and discrimination.
Public Health Outcomes
Framework (cont’d)
• Proportion of children and young people who play games
on a computer 2+ hours on weekdays.
• Proportion of mothers with mental health problems,
including postnatal depression.
• Proportion of parents where parent child interaction
promotes secure attachment in children age 0-2.
• Proportion of parents with appropriate levels of selfefficacy.
• Children, young people and families have access to ageappropriate health information to support them to lead
healthy lives.
Next steps
• DH, as ‘system steward’, draft the Action plan with the
system
• SofS to launch the new ambition for children and young
people’s Health Outcomes in the New Year
• Establish new governance arrangements for delivering
the Strategy, with CMO chaired Children and Young
People’s Health Board.
• Re-establish the Forum under Christine Lenehan and Ian
Lewis as co-Chairs, with amended membership.
• First meeting of the new Forum 13 February 2013.
• First Annual Summit to be held in September 2013.
Summary
• The facts tell us we need to improve outcomes for
Children and Young People.
• The Children and Young People Health Outcome Forum
sets out the outcomes across the sectors.
• The reforms provide the opportunity to bring together the
key players to transform children and young people’s
health outcomes
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