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Moving from Fragmentation to Integration

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. Under 18 conception rate.

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Moving from Fragmentation to Integration

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  1. Moving from Fragmentation to Integration Setting The National Scene Karen Turner, Deputy Director, Children, Families and Health Inequalities Department of Health

  2. Current facts and figures

  3. 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.

  4. Substance abuse • 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. Source: Smoking, drinking and drug use among young people in England in 2011, The Health and Social Care Information Centre

  5. 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. • 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 • 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

  6. Mental health • 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.

  7. Mental health • 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

  8. Hospital inpatient emergency admissions for intentional self-harm among 13-18s • 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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  10. 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 Mutuality; holding each other to account to deliver improvements

  11. 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

  12. 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.

  13. 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

  14. NHS Outcomes Framework 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.

  15. Public Health Outcomes Framework 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.

  16. 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 self-efficacy. Children, young people and families have access to age-appropriate health information to support them to lead healthy lives.

  17. 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.

  18. 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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