Reading the headlines from the latest QualityWatch report it is hard to see how the statistics could look worse for children and young people. Uncomfortable reading as it can be, looking at the data behind the headlines is the first step to making real improvements.
The report tells a worrying story of increasing emergency hospital admissions for the under 25s and a staggering 30% increase for the very youngest. The first of its kind in a decade, the report comes at a time when children and young people’s health is centre stage; with heightened public awareness about the relationship between health issues in childhood and the impact on health in adulthood.
QualityWatch are clearly right to focus on the experiences of children and young people. The National Children’s Bureau report, ‘Poor Beginnings’ (NCB 2015) showed significant variation in children’s health depending on where they live in the country.
More than three years ago the Lambeth Early Action Partnership (LEAP) formed to take action and improve the lives of children and families in this diverse area of London. LEAP brings together health agencies, Lambeth Council, local voluntary sector agencies, parents and community. Facilitated by NCB, this is a key partnership in a local community, leading innovation and influencing the way that services are accessed and work together.
We started out with publicly available data relevant to the early years, supplemented by a wellbeing survey of the local area. This needs analysis presented a picture of poor health outcomes, underpinned by risk factors such as overcrowded housing and indicators such as a higher than expected usage of Accident and Emergency services.
As with many in-depth reviews, this was a resource-intensive exercise where we would have welcomed the QualityWatch ‘Emergency hospital care’ report providing an England-wide context and credible research.
Infant emergency admissions
The rise in infant emergency admissions highlighted in the QualityWatch report is (not surprisingly) also borne out locally. Most of the A&E/admissions data (NHS England) now shows Lambeth as similar to the England average. However, the two indicators with worse outcomes in Lambeth are A&E attendances for children under a year and hospital admissions for dental caries in children aged 0-4.
Our local wellbeing survey found that parents of young children had a perception of poor health in their children, and chronic ill health in themselves. There were other issues too, but the poor health was a stark reality. We were concerned to find out the cause of this persistent ill health, and what could be done to prevent it.
Significantly, we found that babies and very young children were not consistently accessing the ‘universal’ services that are intended to promote good health outcomes. Could we conclude that information for parents may be lacking on where to go for advice on childhood disease and chronic health conditions?
We set about co-designing a programme of evidence-informed interventions and local innovation, taking account of what was already available, involving parents and practitioners, with an ambition to improve take up of the universal services and switch the pendulum from crisis spend and heavy end intervention towards getting in earlier and prevention.
Crucially, we did not want to label this ‘early intervention’. This is about high quality, integrated children’s services, derived through statutory agencies working effectively and having a common purpose. Good children’s services, rather than just good enough.
There is a fine balance where the health of young children is concerned – we would never wish to deter parents from accessing emergency services or cause delaya in seeking advice. That ‘good’ children’s service for everyone is about a strong community pathway, especially in the early years, making sure that the universal framework that we have of a GP, Health Visiting and community services are as accessible and connected as they needed to be.
Hospital or other services?
The ‘Emergency hospital care’ report refrains from comment on whether a parent is using A&E when they could be seeing a GP, quite rightly. From our place-based programmes we do know that some families have many challenges in their lives, therefore organising healthcare sooner rather than later usually requires a change in behaviour. To have successful community services means change all round.
Through LEAP, we have recruited volunteer Parent Champions, who are well placed to provide information on services. There is a multi-agency commitment to redefining the Early Years Pathway and a GP Failsafe programme in development, to mention a few of the local approaches. This is a local evolution of public health and early years, based on the insights of those that live and work in the heart of the community. Three years (almost) in and with a further three years until we start to show results, means grit and determination to keep going. This is not a trajectory that changes quickly.
I welcome this QualityWatch report, which gives a benchmark for improvement. Let’s do more to tell the stories that illustrate what is happening behind the data, share our ambitions for community-based services for the future and talk frankly about the reality of driving change for children.