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

20th January 2015

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 show a slight decrease in the proportion of Year R measured as having excess weight compared to the previous 3 years; The proportion of Year 6 measured as having excess weight remained stable, however within this, the proportion measured as obese has increased slightly on 2012/13.

Extensive partnership work is continuing between Public Health, NHS England Area Team and the Child Health Information System surrounding the ongoing data quality issues around the recording and reporting of breastfeeding prevalence, the work is focusing on finding long-term solutions to a system wide problem.

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)	95.8% (G)
NCMP Year R Excess Weight (overweight or obese)	22.9%	21.7%	21.7%	20.8%
NCMP - Participation Year 6	93.2% (G)	95.0% (G)	95.4% (G)	93.9% (G)
NCMP Year 6 Excess Weight (overweight or obese)	33.3%	32.7%	32.7%	32.7%

2.2 2013/14 child measurement data was released early December 2014; participation rates continue to exceed the 85% national target rate which ensures the significance of the figures. There was a decrease in the proportion measured in Year 6; this was expected following notification by the provider of 2 schools having the Year 6 group unmeasured by the end of the 2013/14 programme. Measures have been taken by the provider to ensure that this will not happen in the 2014/15 cohorts.

2.3	There was a slight decrease in the proportion of children in Year R measured as having excess weight from the previous 3 years. Within the excess weight category, 12.6% were overweight and 8.2% were obese; both of which were below national rates of 13.1% and 9.5% respectively.

2.4	For Year 6 the excess weight proportion continued to remain stable at 32.7%, and just below the national rate of 33.5%. Within the excess weight category, there has been an increase in the proportion who are obese, increasing from 18.2% in 2012/13 to 18.5% in 2013/14; this has not followed the national obese proportion which decreased slightly form 19.2% in 2012/13 to 18.9% in 2013/14

2.5	For all categories within the NCMP programme (underweight, healthy weight, overweight, obese) Kent remains either better or similar to national proportions in 2013/14.

2.6	Continuing data quality problems have meant that breastfeeding prevalence figures in Kent continue to fail the validation process and therefore have not been nationally published for 2013/14 and into 2014/15; extensive partnership work between Public Health, NHS England Area Team and the Child Health Information system (CHIS) provider across Kent and Medway are ongoing to identify where problems occur and find solutions to remedy this. This forms part of the wider partnership work on transitioning the Health Visiting service from NHS England to KCC commissioning.

2.7	The table below provides the proportion of women totally or partially breastfeeding at the 6-8 week check, with the unknown statuses removed from the equation, they show the proportions for Q1 2014/15 against the same time period last year. These proportions should be used with caution as they may substantially change once the unknown statuses are completed.

Proportion of women who totally or partially breastfeeding at 6-8 week check
Q1 2013/14	Q1 2014/15
Ashford CCG	42.7%	41.5%
Canterbury & Coastal CCG	48.2%	47.3%
Dartford, Gravesham & Swanley CCG	41.3%	40.4%
South Kent Coast CCG	39.9%	36.8%
Swale CCG	35.3%	25.9%
Thanet CCG	33.9%	37.7%
West Kent CCG	51.4%	53.4%

2.8	The level of unknown statuses across the CCGs exceed the 5% threshold for unknown, in Q1 2014/15 the unknown proportions range from 11.3% in Ashford CCG to 38.4% in Thanet CCG. The national proportion of unknown statuses was 11.8%.

2.9	A new community infant feeding service has commenced which offers peer support to new mothers and families, with a focus on areas of most need, and will provide access to a specialist lactation consultant where necessary. The new service will also support GP practices to improve the quality of data and the process of data transfer between GPs and the Child Health Information system.

3.	Annual Public Health Outcomes Framework (PHOF) Indicators

3.1	There have been no updates or additions to the annual PHOF indicator on conception rates; 2013 conception rates are expected to be released early 2015.

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	The table below outlines the proportion of women with a smoking status at time of delivery by CCG and England for comparison purposes. Not only is there variety between the CCGs there is also variety within the CCGs from quarter to quarter.

Health & Social Care Information Centre	Q2 2013/14	Q3 2013/14	Q4 2013/14	Q1 2014/15	DoT
Ashford CCG	10.2%	9.0%	13.9%	10.1%
Canterbury & Coastal CCG	12.6%	13.7%	15.4%	8.6%
Dartford, Gravesham & Swanley CCG	11.2%	15.0%	12.3%	14.9%
South Kent Coast CCG	15.2%	15.2%	18.7%	13.8%
Swale CCG	26.1%	9.1%	26.8%	17.4%
Thanet CCG	17.0%	16.7%	17.0%	18.8%
West Kent CCG	9.6%	9.7%	7.5%	9.4%
England	11.8%	12.0%	12.0%	11.5%

4.	Health Visiting

4.1	As outlined in the previous performance report to Cabinet Committee, In October	2015, KCC will assume responsibility for commissioning health visiting services in	Kent. As a separate paper on Health Visiting is on the agenda for this Cabinet	Committee, please refer to the relevant sections within that report for performance	figures.

5.	Conclusion

5.1	The 2013/14 NCMP figures continue to show Kent as being either better or as having similar proportions to national; Excess weight in Year R has decreased and Year 6 has maintained. Further analysis is underway to look into variation within Kent and across the categories. Extensive partnership work across the agencies involved in Health Visiting in Kent continues in readiness for transition of commissioning the service, alongside this is a multi-agency effort to remedy poor breastfeeding data quality.

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.