Teresa Roche, Director of Public Health to present a report which focuses on the first 1001 days; from conception to a child’s second birthday.
After a brief introduction by Cllr Roche, the Director of Public Health delivered a short presentation to introduce the Public Health Annual Report 2019 - The First 1001 Days.
Annual Report of the Director of Public Health (DPH)
• Statutory duty to write independent report on health and wellbeing of local population
• The annual report continues to be one of the ways in which DPH can highlight specific issues that will improve the health and wellbeing of the
population of Rotherham
• 2018 previous Annual Report focused on ‘What keeps us happy and well in Rotherham?’
Progress on recommendations from last year (2018)
1) Re-launch of Joint Strategic Needs Assessment (JSNA) – Community insight to supplement the data was impacted by Covid-19 but to note the importance of work on loneliness and isolation and focus on mental health and mental ill health. Increased focus on the local economic plan in readiness for jobs coming back and links to numbers 5 and 6.
2) Raising awareness/training mental health – positive impact of men’s small grants programme.
3) Workforce development and training as part of the Thriving Neighbourhoods Strategy – Getting closer to communities and more assessment based approach
4) Support the expansion of the offer of social prescribing
5) All partners to continue to support the ‘Working Win’
6) Rotherham launch of the South Yorkshire BeWell@Work Award
7) Interactive artwork at the Rotherham Show
Under Making Every Contact Count 362 people have been trained. With Five Ways to Wellbeing mental health, alcohol awareness and sleep awareness courses had all run, more health champions had been recruited and over 100 people trained in dementia awareness. 15 schools were involved.
2019 Annual Report - Focus of Report
• The First 1001 Days – A legacy for life
• Key Influencers on the First 1001 Days
• Preparing for Parenthood
• The First 2 Years of Life, including showcasing what we are doing in Rotherham
The First 1001 Days – Window of Opportunity
• Between conception and a child’s second birthday
• Critical to life-long health and wellbeing
• Not every baby has the same opportunities in Rotherham
• Impact of parental behaviours
• Wider societal influences e.g. living in areas with polluted air
In Rotherham we will develop, jointly with all stakeholders and partners, a clear and ambitious plan to improve support for children, parents and families in the first 1001 days; key actions are outlined below.
What we can do together
Work in a partnership with our services to improve the health and wellbeing of families and their young children. In particular have a focus on:
The First 1001 Days, between conception and a child’s second birthday, was critical to life-long health and wellbeing as it was difficult to reverse negative consequences beyond 1001 days. From the science it was known that not every baby born in Rotherham had the same opportunities as their peers for a healthy and fulfilled life, due to several parental behaviours such as smoking and drinking alcohol during pregnancy, not eating a balanced diet and taking little exercise. The well-being of the family could be influenced by wider determinants of health, including socio-economic, environment, income and inequality. Early public investment in the first 1001 days set the foundation for greater societal return on such investment, helped to reduce inequalities and should lessen the requirement for expensive interventions later in life.
Cllr Roche emphasised the JSNA was more interactive and interesting than previous iterations and that no major decision making should take place without taking account of the JSNA. Information would also feed through into ward profiles with LGA support as on the previous ones.
Members asked about the effects of living in cold houses on babies and their respiratory systems, as years ago no houses had central heating or indoor bathrooms. Not everyone living in a cold home would have respiratory problems and equally a home lacking in ventilation or that was too hot could cause problems. Dampness increased the risk of asthma and when it was cold the cilia in people’s noses did not move so well which could affect the respiratory system. In damp/cold houses people tended to congregate in one room, which could have other consequences such as impacting on young people trying to do their homework. Reference was made to the Hotspots initiative which included trying to encourage people to improve their home insulation.
Assurance was given that the report and recommendations included disabled children and disabled mothers and that within the concept of universal proportionalism, there would be tailored support.
Trends for smoking and drinking showed an upward trajectory and Members questioned the likely impacts on babies, young people and parents. The advice was no alcohol in pregnancy to minimise risk as it soon passed through the placenta to the baby and thus impact on development. Women needed to have as healthy a pregnancy as possible and to reduce risks to the baby.
Meeting the target for smoking in pregnancy had been a struggle but this was one of a few that had improved during Covid-19. There was some evidence available on the impact of e-cigarettes and pregnancy but e-cigarettes were considered less harmful than other cigarettes due to the other harmful chemicals (4000+) in the latter besides the nicotine.
With regard to substance misuse, Members highlighted the proliferation of discarded nitrous oxide capsules during lockdown for the pandemic. It was agreed to respond to these concerns through a report to a future meeting.
The breastfeeding buddies initiative to encourage mums was viewed positively but Rotherham still had comparatively low numbers. Members questioned what more could be done to increase the number of women breastfeeding up to six months as recommended by the World Health Organisation. Numbers had increased but could be improved and work continued with Rotherham Hospital who were accredited under the Unicef breastfeeding friendly scheme and were going for an additional award. Rotherham sought to be a breastfeeding friendly town and to work with other towns and communities to even reach borough-wide, which was welcomed by HSC. Breastfeeding needed to be normalised and seen as Rotherham had generations in families who had never breast fed. Work with midwives continued to encourage breastfeeding whilst recognising that for many women it was difficult. Another issue was that many women returned early to work and although continuing to breast feed could be managed it was not easy.
Concerns were raised as to whether companies were still permitted to promote formula products and give free samples, including the meals in jars which were not as good as home prepared food. This would be doublechecked as the understanding was that sponsorship of leaflets or training had ceased.
Questions were asked about the ability to influence the growing trajectory of child poverty and what fell within parental and local authority control as opposed to national economic policy, plus how to exert influence at societal level. Child poverty should be addressed locally by taking advantage of the Sheffield City Region, such as grant funding, to tackle family poverty and societal issues. Challenge and Member support were still needed through Thriving Neighbourhoods and at community level. Universal proportionalism would be key.
Members requested statistics regarding the Healthy Foundations accreditation scheme for early years settings on the numbers who had achieved or were working towards each level. This data would be obtained from Children and Young People’s Services. It was queried that health and safety only featured at gold level in the scheme rather than being included at the start. This would be followed up to check that it was implicit not just implied.
With the move to a whole family approach from SureStart, Members queried if this had resulted in better engagement from birth. Under SureStart certain communities of special need had been targeted but things had shifted and engagement as a whole had improved. Children’s centres had really helped support the overall Public Health agenda – stopping smoking, promoting breastfeeding, weaning and bonding – and were a useful resource for prevention.
The question was asked as to whether the report was challenging enough and critical enough to the Council and all partners on the steps to tackle health inequalities. The slant of the report had been from an enabling rather than a demanding stance.
With greater understanding of the impact of Adverse Childhood Experiences (ACE), Members probed how this would now go forward into actions and stressed the need to tackle health inequalities and to push the Public Health agenda even more in light of Covid-19. Working with other directorates on the report had raised this up the agenda, certainly much more with CYPS now. There was a challenge to recognise them all individually and earlier, a need for awareness raising and then to see this reflected in commissioning. Parenting courses would be a key element and follow up, using all the means available to services to support people. Recommissioning of the 0-19 service would see it embedded in there for all community support in the multi-agency approach.
Cllr Roche referred to a recent seminar in which Marmot referred to the lost last ten years and would share the seminar slides. The Health and Wellbeing Board would refocus on the Marmot principles as part of the recovery from Covid-19 and the refresh of the Health and Wellbeing Strategy would take account of the DPH annual report. ACEs needed to be a fundamental part as they represented the sharp end of not getting things right.
Cllr Cusworth drew attention to the connection between food poverty and child/family poverty and confirmed that the Improving Lives Select Commission were working on the issue of holiday hunger. Free school meals had been extended through the summer holidays. Key issues were how this was managed as it was fragmented at present and increased food bank reliance in economically difficult times. Updates could be shared with HSC.
Members sought greater assurance that in terms of the refresh of the JSNA, it would now act more as a driver to inform service commissioning, based on needs but also reflecting our assets, than the previous version. In addition, with a move to more sub-regional partnership working HSC asked if councils and partners taking account of and shared their JSNAs. It was more of an asset not a deficit model and all partners should take account of it to influence commissioning. One of the reasons for involving more agencies in its development had been to make it more meaningful and relevant for them. It would also inform the ward plans.
Housing was mentioned in the report but not covered in the seven areas of what we can do together but HSC’s expectation was that those links were present and would continue, including with the Selective Licensing initiatives. Housing was a vital element within the Marmot principles and part of the holistic approach. It would be included in the refresh of the Health and Wellbeing Strategy. Aim 4 in the strategy was the wide reaching one and more services were now involved with the Health and Wellbeing Board, not just Public Health but every directorate and it needed that wider working to enable progress. There was also the Rotherham Place Plan.
The Chair inquired about work to be done with parents to engender good oral health when children first start cutting their teeth. Rotherham still had an oral health team that worked in children’s centres and schools on tooth brushing clubs as well as awareness raising with parents. Dentists look for risks and services were exploring possibilities for further work, even possibly water fluoridation.
The DPH was thanked for presenting her report.
1) That the Health Select Commission work jointly with all stakeholders and partners, to develop a clear and ambitious plan to improve support for children, parents and families in the first 1001 days, with particular support for the seven areas highlighted:
1. Reduction in Smoking in Pregnancy rates
2. Improve diet and nutrition
3. Promote physical activity
4. Increase breastfeeding prevalence
5. Increase Ages and Stages Questionnaire -3
6. Improve air pollution
7. Referrals to Public Health Commissioned Services, Get Healthy Rotherham, Drug and Alcohol Services, as well as supporting Early Years and 0-19 Integrated PH Nursing
2) That Public Health submit a briefing paper on the use of nitrous oxide and the Council’s approach and policy in relation to its misuse.