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

Andrew Scott-Clark, Acting Director of Public Health

To:	Children’s Social Care and Health Cabinet Committee

Date:	9th July 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.

There have been no updates to the commissioned services since the previous report; the progression of the National Child measurement programme continues to be monitored regularly. Infant feeding prevalence figures continue to be under scrutiny and assistance was requested at the recent Kent Health & Wellbeing Board for members to emphasise the importance of collection and reporting with appropriate colleagues.

Recommendation(s): The Children’s Social Care and Health Cabinet Committee is asked to

- note the current performance and actions taken by Public Health

- agree the inclusion of the presented Health Visitor information

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 are 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 performance against these indicators relevant to this committee is laid out in the table below with more detail available in appendix 1.

Indicator Description	2010/11	2011/12	2012/13	2013/14	Trend
Prescribed Data Return
National Child Measurement Programme - Participation Year R	95.0%	93.7%	92.2%	Not yet available
NCMP Year R Excess Weight (overweight or obese)	22.9%	21.7%	21.7%	Not yet available
National Child Measurement Programme - Participation Year 6	93.2%	95.0%	95.4%	Not yet available
NCMP Year 6 Excess Weight (overweight or obese)	33.3%	32.7%	32.7%	Not yet available
Local Indicator	Q1 12/13	Q2 12/13	Q3 12/13	Q4 12/13
Proportion women breast feeding (partial or total) at 6-8 weeks	40.2%	40.5%	41.9%	39.8%

2.2	Participation in the child measurement programme has continued to be good, far exceeding the 85% target. Data for 2013/14 has not yet been published but local information indicates that Year 6 is currently above 90%.

2.3	Data quality problems have meant that breastfeeding figures have still not been published for Kent although local information indicates that prevalence remains below the national average and falling. A fall in performance was anticipated during the tendering process and given the market maturity. The latest assurance framework report to the Kent Health & Wellbeing Board requested assistance from Board members to highlight the importance of accurate completion and submission of infant feeding figures, both with Practices and the Child Health Information System.

3.	Annual Public Health Outcomes Framework (PHOF) Indicators

Annual PHOF Indicators	2008	2009	2010	2011	2012	Trend
Under 18s conception rate (per 1,000)	36.5	34.1	34.6	31.0	25.9
Annual PHOF Indicators	2010/11	2011/12	2012/13	Movement
Smoking status of pregnant women at time of delivery	16.8%	15.2%	*

RAG is against National performance. * Not published due to data quality concerns

3.1	Kent has continued to experience decreases on its under 18 conception rate; initially the rate was better than the national rate, moving to a similar rate from 2010 to 2012.

3.2	2013/14 data on smoking in pregnancy has not yet been published because of data quality concerns. Local data sourced by the Kent and Medway Public Health Observatory are presented here as a proxy measure, however they are subject to amendment following validation.

Local Data	Q1 13/14	Q2 13/14	Q3 13/14	Q4 13/14	Movement	Full 13/14
Smoking status of pregnant women at time of delivery figures	13.6%	12.8%	12.8%	13.1%	13.1%

3.3	Public Health commission, and have in development, programmes aimed at tackling pregnant women who smoke. One recently commissioned programme is BabyClear which trains midwives to identify pregnant women who smoke and engage them in stop smoking services. They provide a 24 hour follow-up intervention. The service to date has

Identified 243 midwifery staff as requiring training and CO monitors

Delivered training to 87 midwives, and all should be trained by mid-June

26 Stop Smoking advisors have undertaken additional training to increase knowledge and skills in supporting pregnant women.

A review of provision of all smoking cessation provision is underway to conclude in July, which will inform new models to be commissioned throughout 14/15.

4.	Health Visiting

4.1	In October 2015 KCC will inherit the Health Visiting Service. The (Acting) Director of Public Health and the Head of Commissioning have met with NHS England recently to discuss the Health Visiting Service and will be joining the performance monitoring meetings of the provider Kent Community Health Trust.

4.2	A key target is to increase the workforce numbers. NHS England currently commissions the Health Visiting Service in Kent, and available figures (April 2014) show that there were 248.25 FTE Health Visitors, against a target of 258. FTE1. A more detailed report is expected which will provide greater detail on geographical coverage of Health Visitors and trajectories going forward.

5.	Conclusion

5.1	Overall, performance on key public health indicators relating to children has been mixed. Teenage pregnancy rates have declined and rates of childhood obesity appear stable but rates of breastfeeding remain below the national average.

5.2	Public Health are working with a range of partners and service providers to improve performance in these key areas to help ensure that all children in Kent have the best start in life.

6.	Recommendation(s)

Recommendation(s): The Children’s Social Care and Health Cabinet Committee are asked to:

- note the current performance and actions taken by Public Health

- agree the inclusion of the presented Health Visitor information

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: Acting Director of Public Health

0300 333 5176

Andrew.scott-clark@kent.gov.uk

Appendix 1:

Key to KPI Ratings used:

GREEN	Target has been achieved or exceeded
AMBER	Performance at acceptable level, below Target but above Floor
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.

NCMP: Participation in the Annual National Child Measurement Programme	GREEN

Trend Data – Annual	2010/11	2011/12	2012/13
Year R	Year 6	Year R	Year 6	Year R	Year 6
Participation Kent	95.0%	93.2%	93.7%	95.0%	92.2%	95.4%
RAG Participation	Green	Green	Green	Green	Green	Green
Participation England	93.4%	91.8%	94.2%	92.4%	94.0%	92.7%
Kent % Excess Weight (Overweight or obese)	22.9%	33.3%	21.7%	32.7%	21.7%	32.7%
National % Excess Weight	22.6%	33.4%	22.6%	33.9%	22.2%	33.3%

Commentary
The programme achieves high levels of participation and has been consistently above the 85% target. For 2012/13 participation rates for Reception year were 92.2% and 95.4% for Year 6, further ensuring the statistical significance of this indicator. The proportion of Reception year children measured with excess weight has decreased slightly from 22.9% in 2010/11, to 21.7% in both 2011/12 and 2012/13, remaining just below the national percentage of 22.2% in 2012/13. For Year 6 the percentage measured as having excess weight remained stable at 32.7% in 2012/13. Kent remains just below the national obese measurement of 33.3%. It is critical that the programme is effectively linked to initiatives to reduce childhood obesity. Public Health is committed to prioritising action to reduce childhood obesity further. This is one of the core opportunities to work effectively across the Council as well as with other partner colleagues. The NCMP relates to Public Health Outcome Framework Indicators 2.06i and 2.06ii (Excess Weight – obese and overweight)
Data Notes: Higher values are better for Participation. Obesity lower values are preferred. Performance assessment for this indicator is based on the participation rate. Obesity for children is defined as being above the 95th percentile on the Body Mass Index, based on the weight distributions recorded between 1963 and 1994. Data includes state maintained schools only is based on schools location, not pupil address. Data Source: HSCIC. Indicator reference: PH/CYP/01

Infant Feeding - Proportion of women breast feeding at 6-8 weeks	-

Trend data – by Quarter	2012/13
Q1 (Apr -Jun)	Q2 (Jul-Sep)	Q3 (Oct-Dec)	Q4 (Jan-Mar)	Full 2012/13
Number of infants due 6-8 week check	4,555	4,336	4,531	4,200	17,622
Number of infants recorded as totally or partially breastfed at 6-8 weeks	1,833	1,754	1,897	1,671	7,155
% of infants totally or partially breastfed as a proportion of those due a check	40.2%	40.5%	41.9%	39.8%	40.6%
RAG Rating (46%)	Amber	Amber	Amber	Red	Amber
National (where available)	47.1%	47.5%	47.4%	46.6%	47.2%

Commentary
Following re-instatement of the submission process for Infant feeding, there has been one publication in 2014 where due to failing the data completion threshold, no Kent figures were published. Public Health continues to engage and work with partners to increase awareness of the importance of accurate and complete recording. The tender process for a new service will go out in April 2014 with the aim of the new service being in place from October 2014. Previous data have highlighted particular concerns about prevalence of breastfeeding in some localities and local work is taking place in these areas. Community services have been re-provided short-term in West Kent and Swanley to fill a gap, services in Dartford and Gravesham were re-provided earlier in the year. Breastfeeding prevalence is Public Health Outcome Framework Indicator 2.02i
Data Notes: Source: DH Integrated Performance Measure. Indicator Reference PH/AH/03