Karen turner 5th nov 2012 confederation of heads of yp services annual convention final

Confederation of Heads of Young People’s Services – Annual Convention 5th & 6th November 2012

Health and Wellbeing in Young People

Karen Turner

Mortality in Childhood (0 - 14)

UK compared to European 12

Hospital inpatient emergency admissions for intentional self-harm

among 13-18s

• In 2010/2011, the number of admissions for those aged 13-18 years was 17,000. This is a rate of 45 per 10,000 population aged 13-18 years.

• Hospital emergency admissions rates for intentional self-harm among 13-18 year-olds increased by 16.9 per cent from 2006/07 to 2010/11.

• Among 13-18s, females are at least three times more likely to be admitted for self-harm than males.

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Source: Hospital Episode Statistics (HES)

Under 18 conception rate

• Overall conception rate in under 18s in England in 2010 was 35.4 per 1000 women in this age group.

• The conception rate among under 18s has declined from 40.6 per 1000 women in 2006. Over the same period the overall conception rate amongst all women has increased from 78.5 to 82.5 per 1000 women in all age groups.

• Highest rate of under-18 conception is in the North-East (44.3 per 1000 women ) and lowest in the South-East (28.3 per 1000 women).

• Under-16 conception has remained relatively stable from 2006 to 2009, although it did decline in 2010.

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Substance abuse

• In 2011, around one in six (17%) pupils reported ever having taken drugs compared to 29% in a previous survey in 2001.

• 12% of pupils reported having taken drugs in the last year in 2011, and this has declined steadily from 20% in 2001.

• Drug use in the last year was reported by similar proportions of boys and girls.

• Drug use in the last year increased with age: 3% of 11 year olds reported taking drugs in the last year, and this increased to 23% amongst 15 year olds.

• Early drug use was more likely to be volatile substances in younger pupils while those aged 14-15 reported taking cannabis as the first drug they tried.

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Source: Smoking, drinking and drug use among young people in England in 2011, The Health and Social Care Information Centre

0

5

10

15

20

25

30

35

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Perc

ent

Took drugs in the last month, lastyear and ever: 2001-2011

Ever taken drugsTaken drugs in the last yearTaken drugs in the last month

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Smoking prevalence at 15 years

• Smoking is the primary cause of preventable morbidity and premature death. There is a large body of evidence showing that smoking behaviour in early adulthood affects health behaviours later in life.

• The Tobacco Control Plan sets out the Government's aim to reduce the prevalence of smoking among both adults and children and includes a national ambition to reduce rates of regular smoking among 15 year olds in England to 12 per cent or less by the end of 2015.

• The indicator shows the number of persons aged 15 who are self-reported smokers as a proportion of the total number of respondents (with valid recorded smoking status) aged 15

Source: Smoking, drinking and drug use among young people in England in 2011, The Health and Social Care Information Centre

• Between 2001 and 2011, the proportion of pupils aged 15 who report that they are regular smokers fell from 22% to 11% (Regular smokers are defined as usually smoking at least one cigarette per week).

• In 2011 there was no difference in smoking between boys and girls. Previously girls reported smoking more than boys.

0

10

20

30

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Perc

ent

Proportion of 15 year olds who were regularsmokers, England

OverallBoysGirls

Mental health

• One in ten children aged 5 – 16 years has a clinically diagnosable mental health problem

• Half of those with lifetime mental health problems first experience symptoms by the age of 14, and three quarters before their mid-20s

• As part of the ONS wellbeing programme, a children and young people’s wellbeing project has been set up to ensure that the Measuring National Well-being Programme covers measures of children and young people’s well-being

• Self-harming in young people is not uncommon (10-13% of 15 – 16 year olds have self harmed)

• Some children are significantly more likely to experience mental health problems than others – e.g. those with disabilities, LAC, and those living in families with complex and multiple problems.

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Mental health

• There is a 49-fold variation across PCTs in rate of inpatient admissions for mental health disorders per 100,000 population aged 0-17 years, where length of stay was >3 days.

• Rate ranges from 3.4 to 166.1 admissions across PCTs in England

• No statistical correlation between admission rates and deprivation i.e. the level of deprivation does not have a significant impact on the rate of admissions. This result is borne out by high rates of admission in South West, South Central and South East Coast SHA regions.

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London

Rate of inpatient admissions >3 days’ duration in children per 100,000 population aged 0–17 years for mental health disorders by PCTDirectly standardised rate 2007/08–2009/10.The highest rates are highlighted in dark blue, lowest rates in light blue

Children and Young People’s Health Outcomes Strategy

Secretary of State for Health asked the independent CYP Health Outcomes Forum to:

• Identify the health outcomes which matter most for children and young people,

• How well they are supported by the existing indicators in the Public Health and NHS Outcomes Frameworks, and

• How the different parts of the health (and wider system) will contribute and work together in the delivery of these outcomes.

The Forum’s 8 themes

•Health outcomes that matter most for children, young people and their families

• Putting children, young people and their families at the heart of what happens

• Acting early and intervening at the right time

• Integration and partnership

• Safe and sustainable services

• Workforce, education and training

• Knowledge and evidence

• Leadership, accountability and assurance

Young People’s Voices and Rights

The Forum found:• Young people felt that insufficient attention was paid to their health and well-being

needs and

• Too many public health campaigns are aimed at adults

The Forum said:• Young people have the right to be involved not just in their own health, but the wider

system

• Young people want and need to be involved in the commissioning, design and development of public health campaigns and services aimed at young people

• Young people need relevant, age-appropriate information to enable them to make informed choices and take responsibility for their own health and well-being

Overview of key Forum recommendations

• 9 new indicators for the Public Health Outcomes Framework and changes to other indicators.

• 5 new indicators for the NHS Outcomes Framework and changes to other indicators.

• A number aimed at organisations within the health system, e.g. NHS CB, PHE, the

MHRA, NICE, CQC, Monitor, on the contribution that they need to make in order that improved outcomes can be delivered.

NHS Outcomes Framework

Proposed New Indicators:

1. Integrated care – developing a new composite measure.

2. Effective transition from children’s to adult services.

3. Age-appropriate services – with particular reference to teenagers.

4. Time from first NHS presentation to diagnosis or start of treatment

A range of other ‘stretch’ indicators, for example:• By 2013/14, DH and the NHS CB should incorporate the views of children and young

people into existing national patient surveys in all care settings.

Public Health Outcomes Framework

Proposed New Indicators: • Number of children and young people living in decent housing

• Educational attainment and progress for all children and young people with LTCs

• Proportion of children who experience bullying

• Proportion of children and young people with mental health problems who experience stigma and discrimination.

Public Health Outcomes Framework (cont’d)

• Proportion of children and young people who play games on a computer 2+ hours on weekdays

• Proportion of mothers with mental health problems, including postnatal depression

• Proportion of parents where parent child interaction promotes secure attachment in children age 0-2

• Proportion of parents with appropriate levels of self-efficacy

• Children, young people and families have access to age-appropriate health information to support them to lead healthy lives

Next steps

• DH, with organisations in the new system, to produce the action plan

• SofS to launch the Children and Young People’s Health Outcomes Strategy before Christmas

• Establish new governance arrangements for delivering the Strategy, with CMO chaired Children and Young People’s Health Board

• Re-establish the Forum under Christine Lenehan and Ian Lewis as co-Chairs, with amended membership

• First meeting of the new Forum 13 February 2013

• First Annual Summit to be held in September 2013.

Child and adolescent mental health service - Promoting good health

and improving practice

Time to change – anti stigma campaign

• New children and young people’s work-stream

• Pilot to test approaches to tackling mental health stigma and discrimination in children and young people

Children & Young People’s MentalHealth e-portal Quality

Driven

User informed

Evidencebased

Outcomesfocussed

1) e-learning modules for:• non-NHS staff in universal settings; teachers, youth workers,

police, clergy, social workers

• NHS staff in universal settings; GPs, paediatricians, nurses, other health professionals,

• School, FE and University counsellors

• NHS funded staff with a specific focus on CYP with mental health problems

2) e-therapies

Evidence based interventions: Children and Young People’s IAPT

(Improving Access to Psychological Therapies)

• Evidence based practice, outcomes monitoring

• Service Transformation for CAMHS

• Funding £8 million a year 2011/12 - 2014/15

• Additional £22 million over 2012/13 - 2014/15

London Collaborative

Reading Collaborative

Salford Collaborative

HEI – Reading UniversityCAMHS PartnershipsOx and BucksWilts, Bath & NESomersetGloucsSwindonBournemouth, Dorset & Poole

HEI – UCL/KCLCAMHS PartnershipsLambeth & SouthwarkHertsSussexWestminsterHaringeyCambridgeWandsworthGreenwich

HEI - Manchester University CAMHS PartnershipsDerbyManchester & SalfordPennine NorthPennine SouthBarnsley

Year 1 Sites

Northumbria Collaborative

South-WestCollaborative

London Collaborative

HEI – Manchester UniversityCAMHS PartnershipsCentral Lancashire North Lancashire Bolton

HEI – Reading UniversityCAMHS PartnershipsBerkshire Bedfordshire Luton Kensington & Chelsea

HEI – UCL/KCLCAMHS Partnerships Tower Hamlets Hackney Camden Islington Waltham Forest Richmond Bromley Croydon

HEI - Exeter University CAMHS PartnershipsDevon Torbay Plymouth

HEI – Northumbria University CAMHS PartnershipsTeesDurhamNorth YorkshireDarlingtonRotherhamDoncaster

Reading Collaborative

Salford Collaborative

Year 2 Sites

Delivering better health outcomes through the new health system

• Young People’s Voices → HealthWatch

• Health and wellbeing boards

• JSNAs/JHWS

• Commissioning for improved health outcomes (public health and treatment and care)

HEALTH & WELLBEING BOARD

What services do we need to commission (or de-commission), provide and shape; both separately

and jointly? – commissioning plans

What does our population & place look like? –evidence and collective insight

So what does that mean they need, now and in the future and what assets do we have? – a narrative on the evidence - the JSNA

So what are our priorities for collective action, and how will we achieve them together? – the JHWS

What are we doing now, how well is it working and how efficient is it? - a analysis on our progress

Engagement with users

and the public

Explicit link from evidence

to service planning

JSNAs and joint health and wellbeing strategies – tools for shared leadership

HWB provides forum for repositioning JSNA as truly jointly owned and leading to joint commissioning decisions to serve the whole population.

The intention of JSNA is to link local needs with commissioning decisions – by adding the layer of the JHWS this link is being made easier for local areas to understand.