From:	Graham Gibbens, Cabinet Member, Adult Social Care and Public Health

Andrew Scott-Clark, Interim Director of Public Health

To:	Children’s Social Care and Health Cabinet Committee

3rd December 2014

Subject:	Public Health Performance – Children and Young People

Classification:	Unrestricted

Summary: This report provides an overview of the performance indicators monitored by the Public Health division which directly relate to services delivered to children, or services which aim to improve the health and wellbeing of children and young people.

National Child Measurement Programme figures for 2013/14 are due to be published in mid-to-late December and therefore no update has been provided within this report. Breastfeeding data continues to be of concern, with data completion not meeting the required standards for publication. Newly-published figures presented on the Public Health Outcomes Framework show a decrease in the proportion of women with a smoking status at time of delivery, Kent has also decreased the smoking rate to just 1% higher than the national rate.

Recommendation: The Children’s Social Care and Health Cabinet Committee is asked to note the current performance and actions taken by Public Health.

1.	Introduction

This report provides an overview of the key performance indicators for Kent Public Health which directly relate to services delivered to children and young people, or services which aim to improve the health and wellbeing of children and young people.

Performance Indicators

There is a wide range of indicators for public health, including the indicators contained in the Public Health Outcomes Framework (PHOF). This report will focus on the indicators which are presented to KCC Cabinet, and which are relevant to this committee. The key to the tables is available in appendix 1.

Indicator Description	2010/11	2011/12	2012/13	2013/14	Direction of Travel
Prescribed Data Return
National Child Measurement Programme (NCMP) - Participation Year R	95.0% (G)	93.7% (G)	92.2% (G)	Not yet available
NCMP Year R Excess Weight (overweight or obese)	22.9%	21.7%	21.7%	Not yet available
NCMP - Participation Year 6	93.2% (G)	95.0% (G)	95.4% (G)	Not yet available
NCMP Year 6 Excess Weight (overweight or obese)	33.3%	32.7%	32.7%	Not yet available

2.2 2013/14 child measurement data is due to be released in December 2014; internal monitoring of the programme indicates that the provisional participation rates have continued to exceed the 85% minimum.

2.3	The 2014/15 child measurement programme commenced in September 2014 with the beginning of the school year; this will continue to be monitored by Public Health throughout the year to ensure participation rates continue to exceed the minimum target and outcomes maintain their levels of significance.

2.4	Data quality problems have meant that breastfeeding prevalence figures in Kent continued to fail the validation process and have not been nationally published for 2013/14; it is important to continue to monitor the indicator, therefore actual numbers for each category have been included below. These are publically available but are heavily caveated against having conclusions drawn from them.

2013/14 CCG	Infants due a 6-8 week check	Total or Partial breastfeeding	Not at all breastfeeding	Unknown breastfeeding status
Ashford	1,391	470	598	323
Canterbury & Coastal	1,857	752	820	285
Dartford, Gravesham & Swanley	3,153	1,055	1,567	531
South Kent Coast	1,978	591	909	478
Swale	1,334	285	640	409
Thanet	1,567	424	810	333
West Kent	5,219	2,236	1,977	1,006

2.5	These figures show that the number of unknown statuses is too high and further measures are needed from the responsible agencies to limit the use of ‘unknown’ as an option in recording and reporting.

3.	Annual Public Health Outcomes Framework (PHOF) Indicators

3.1	There have been no updates or additions to the annual PHOF indicators on conception rates or smoking status at time of delivery since the last committee meeting.

Annual PHOF Indicators	2008	2009	2010	2011	2012	DoT
Under 18s conception rate (per 1,000)	36.5 (G)	34.1 (G)	34.6 (A)	31.0 (A)	25.9 (A)

3.2	It is expected that the 2013 figures on under-18 year old conceptions will be released early in the 2015. Public Health currently does not have any proxy measures.

Local Indicator	Q1 13/14	Q2 13/14	Q3 13/14	Q4 13/14	Q1 14/15	DoT
Smoking status of pregnant women at time of delivery	13.6%	12.8%	12.8%	13.1%	12.6%

3.3	Newly published figures on smoking status at time of delivery gives Kent as having 13.0% for 2013/14; this is a decrease on previously-published figures for 2011/12; where Kent was 15.2%. Although Kent remains worse than the national percentage, Kent has reduced the gap to just 1% above national rates. KMPHO receives and analyses local figures on smoking status. These are presented above, however these are subject to amendment and may differ from future published figures.

3.4	The local figures indicate that there has been a decrease in the proportion for Kent from Quarter 1 2013/14 to Quarter 1 2014/15, albeit with a small fluctuation during 2013/14. Proportions at CCG level are also being monitored, for Quarter 1 2014/15 and range from Swale at 17.4% to 8.6% in Canterbury.

3.5	Local data on smoking status of pregnant women will continue to be monitored alongside the ongoing BabyClear project and activity of the commissioned smoking cessation services. During Quarter 1 2014/15, 58 pregnant women set a quit date with the smoking cessation service, of which 21 had successfully quit at the 4-week follow-up (16 reported not quitting, and 21 were lost to follow-up).

4.	Health Visiting

4.1	In October 2015, KCC will assume responsibility for commissioning health visiting	services in Kent. The Committee will be receiving a report on Health Visiting in the	New Year. KCC Public Health staff are attending the provider performance	monitoring meetings with the current commissioners, NHS England Area Team. In	line with the transition of the Health Visiting Service to Local Authorities, the	Government intends to mandate certain universal parts of the service. These are:

Ante-natal Health Promoting visits

New baby review

6-8 week assessment

1 year assessment

2-2½ year review

4.2	The current key target for the service is to increase the workforce numbers. For May 2015, there is a target of 342.2 whole time equivalents (WTE). Most recently-available figures show that there were 254.07 WTE Health Visitors, against a target of 265.10. Targets are currently under review. These are shown in the table below.

April 2014	May 2014	June 2014	July 2014	August 2014
Actual number of Health Visitors employed - FTE	248.25	250.23	253.63	253.60	254.07
Target number of Health Visitors - FTE	258.10	262.10	263.10	264.10	265.10
Difference	-9.85	-11.87	-9.47	-10.50	-11.03

5.	Conclusion

5.1	Where nationally-published figures are unavailable, local data has been sourced and presented to ensure monitoring by Public Health can continue. Both locally-sourced figures are included in the commissioning plans for Public Health; commencement has begun on the new provision of community infant feeding services in Kent and there is the ongoing BabyClear programme being delivered across Kent in 2014/15.

6.	Recommendations

Recommendation: The Children’s Social Care and Health Cabinet Committee is asked to note the current performance and actions taken by Public Health.

7.	Background Documents

7.1	None

8.	Contact details

Report Author

Karen Sharp: Head of Public Health Commissioning

0300 333 6497

Karen.sharp@kent.gov.uk

Relevant Director:

Andrew Scott-Clark: Interim Director of Public Health

0300 333 5176

Andrew.scott-clark@kent.gov.uk

Appendix 1:

Key to KPI Ratings used:

(G) GREEN	Target has been achieved or exceeded
(A) AMBER	Performance at acceptable level, below Target but above Floor
(R) RED	Performance is below a pre-defined Floor Standard
Performance has improved relative to targets set
Performance has worsened relative to targets set
Performance has remained the same relative to targets set

Data quality note: Data included in this report is provisional and subject to later change. This data is categorised as management information.

Source: Kent and Medway Public Health Observatory