The voice of nursing in the UK

Healthy lives, brighter futures –

The strategy for children and
young people’s health

Fiona Smith
Adviser in Children’s & Young People’s Nursing,
Royal College of Nursing, United Kingdom
Healthy lives, brighter futures is a
joint strategy
 A healthy childhood is critically
important
Children and young people Supported by medical,
are healthier than ever technological, social and
before economic advances

The past decade has seen Helped by more information

continued improvements and support for parents and
more skilled professionals

But we need to do more to To address inequalities,

become world-class current trends and public
concern

The Strategy cements standards and ambitions

Improving children and young people’s physical and psychological health,
by investing in children’s health from the early years, through childhood and
adolescence, will benefit children, families, society and the NHS.
 The Child Health Strategy
• Reflects PSA priorities to:

– Reduce inequalities in infant mortality

– Reduce teenage pregnancy

– Increase uptake of breastfeeding and reduce obesity

– Reduce experience of bullying

– Reduce hospital admissions for children’s injuries

– Reduce preventable child deaths

– Improve services for CAMHS and disabled children

 The Child Health Strategy
•Cements standards and ambitions:

– The NSF for Children Young People and Maternity Services

– High Quality Care for All, NHS Next Stage Review
– Every Child Matters
– The Children’s Plan

and reflects the concerns people raise as:

– Children and Young People
– Parent and Carers
– Practitioners
 Four principles underpin improving users’
experience of services from birth to 19

Informed users Information for mothers, fathers and carers

Public sector provide healthy settings and

Healthy opportunities encourage healthy choices

Responsive services The right services

Extra support for those vulnerable to poorer

Targeted support health outcomes
Continued improvement to services to support
families from pregnancy onwards
Support to parents to give
their children a healthy Achieve long-term aims
start and partners to for children and young
deliver change in every people’s health
area

Pregnancy and the World-class health

early years outcomes
School-age Services of the
children highest quality
Young people Excellent experiences
in using services
Children with
Minimise health
acute and
inequalities
additional needs

Delivery systems transformation

 The scale of the health problem
•High prevalence of risk factors compared to other European
countries (e.g. births to women under 20 years of age; women
smoking during pregnancy

•Risks are not distributed equally; links to deprivation and with a

growing impact of economic recession

•Our rising birth rate, relatively high incidence of teenage

pregnancies and rising proportion of pregnancies in older women
means more risk to manage and a growing target group for health
promotion.

•Increased hospital activity and preventable child deaths

 The scale of the health problem
•1.1 million children with asthma in the UK (3 children in every
classroom)

•Type 2 diabetes likely on the increase as a result of the increased

proportion of obese children

•Disability services lack consistency across the country, with

evidence of unmet need

•Significant prevalence of mental and emotional disorders with

consequences for educational outcomes
 Neonatal and infant mortality:
key facts
Reductions in infant mortality (1970 to 2006) in England & Wales to 5 per
1,000 live births are:
• leveling off
• unevenly distributed (inequalities by region, maternal age and country of birth)
• a poor position compared to other European countries

Range of actions needed to impact on closing the gap in infant mortality,

e.g.
• reducing conceptions in under-18s
• reduce overcrowding in the routine and manual socio-economic group
• reduce the rate of smoking in pregnancy
• reduce the prevalence of obesity and improve infant nutrition
• early booking and optimal pre-conception care

England’s neonatal mortality rate of 3.4 deaths per 1,000 includes

wide variations, from 1.8 in Surrey and Sussex to 4.8 in South West
Midlands
 Long-term conditions and
hospital activity: key facts
• Emergency admissions have increased over the past decade in
the 0-19 age group

• Over 800, 000 emergency admissions of children and young

people in England every year, with wide variations in rates at PCT
level

• Long term conditions accounting for high numbers of emergency

bed days are asthma, diabetes, epilepsy, cystic fibrosis and sickle
cell disorders

• Children in England have one of the worst incidences of type 1

diabetes and one of the worst records of diabetic control
 Long-term conditions and
hospital activity: key facts
Opportunities for health gain: the example of asthma:

– over past six years, average of 27, 500 hospital

admissions each year for asthma in 0-18s

– cost of treating a child with asthma exceeds adult asthma

treatment cost

– the more deprived a child is, the more likely that the child
will attend A&E for an asthma-related admission

– an estimated 75% of current asthma related childhood

hospital attendances are avoidable
 Disability: key facts
•Research suggests 3 to 5.4% of under-18 population has a
disability

•Outreach work is extending into community settings: family

homes; schools; extended schools; children’s centres

•Large variation across PCTs in support systems available to

families to improve quality of life for families

•Parents of 39% of children aged over 5 tell us that their child has
unmet leisure needs
Mental health: key facts
• 1 in 10 children has a mental
disorder

• 4% of children have an
emotional disorder

• Children with emotional

disorders were more than
twice as likely as other
children to have had
unauthorised absence from
school (21% compared with
9%)

• The UK ranked bottom

amongst developed counties
(OECD) for subjective
wellbeing indicator
The prevalence of mental disorders is greater among children and young
people in certain family-types:

Prevelence of mental disorder in children and young people

Neither parents
working

One-parent family

Families where
both parents work

Two-parent family

0% 5% 10% 15% 20% 25%

Sexual Health: key facts
• Teen infection almost
doubled during 90s

• The sexual health of

adolescents in the UK
is poor. It is likely that
an increase in risky
sexual behaviour has
contributed to sexual
health outcomes such
as STIs and unwanted
pregnancy among
young people.
Alcohol consumption is rising
 .. And Britain leads the way
Health Behaviour of School Age Children
 Smoking
Health Behaviour of School Age Children
Sexual Health
 Teenage pregnancy rates are
falling – but not fast enough
50.0
Under 18 conception rate per 1000 females aged 15-17

45.0
Projection of trend
40.0

35.0

30.0

25.0
Trajectory required
20.0
to meet target
15.0

10.0

5.0

0.0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Prevalence of obese children by
parental obesity
 Actions: School-age children +
Young People
• Healthy child
programme for school-
age children to be
developed

• National Healthy
Schools Programme to
be strengthened

• PE and sport in schools

to be increased
(Olympics)
 Actions: School-age children +
Young People
• Extending free school meals
to more children

• Personal, Social, Health and

Economic education to be
improved and statutory

• ‘You’re Welcome’ standards

to be rolled out

• Increase young people’s

knowledge of effective
contraceptive services in a
range of settings
 Looking back
Why was the school medical service
founded in the UK?
Poor health of recruits for the 1st World
war

Workforce calculations
1 school nurse was needed for every
2,500 children
 The school nurse:
• is a specialist
practitioner working
across education and
health

• provides the link

between school, home
and the community

• needs to have
advanced and specialist
knowledge and skills to
meet the needs of
children and their
families
 The role of the school nurse:
• health promoter

• health educator

• works in collaboration with others such

as teachers, youth workers and
counsellors

•provides access to confidential advice

and guidance on a range of issues

• enables and empowers young people

to make healthy life choices which affect
them throughout their lives
 The school nurse:
Health Priorities
• delivers on health priorities by
• Accidents providing information about
• alcohol and drugs areas such as good nutrition,
exercise, smoking, mental
• smoking cessation health, drugs and sexual health
• mental health
• obesity, nutrition and • identifies vulnerable children
physical activity and young people, implementing
• sexual health and early interventions and referring
teenage pregnancy. to specialists and other sources
• safeguarding and of support when required
promoting children
and young people’s
welfare
 The role of the school nurse:
• shaping and influencing
policies across the
school environment to
tackle issues such as
bullying, the provision
of safe drinking water
and clean toilet
facilities

• drop-in advice sessions

enable direct access to
health information from
a nurse
 School Nurses today ………..

They used to check for nits, but 60 years after the NHS was founded
school nurses have a very different role……..
http://news.bbc.co.uk/1/hi/england/7493562.stm
Children and young people are
a high priority
•Challenges persist
– e.g. Infant mortality, teenage pregnancy, hospitalisations, LTC
management, disability, mental health

•New challenges arising

– e.g. Obesity, autism, service redesign, NHS reform

•Unacceptable variations in risks and outcomes

•Children’s early experiences can have lifelong consequences: How do we

ensure prevention early intervention and support

•No room for complacency: The Child Health Strategy is the vehicle for
making it happen
 Investing in school nursing -
long term outcomes
School nursing is a universally accessible service,
non stigmatising and acceptable to most families
and school communities

Investment in school health services has the

potential to make a considerable difference to
health of the future population
 The RCN position
• The RCN recognises the importance of
school nursing

• The RCN school nurse campaign calls

for a need to invest in school nursing
services

• The RCN wants to see a qualified nurse

in every school
Thank you
Contact details:

Fiona.smith@rcn.org.uk

Tel: 020 7647 3753