Agenda item

The Committee considered the report of the Director of Public Health that provided Members with an update of the progress made in addressing the Best Start in Life (BSIL) priorities and highlighted the importance of early intervention and prevention in the first 1001 critical days.

The report provided a brief update on the work undertaken to address some of the key priorities’ progress and challenges. It also outlined some of the next steps for improving the actions as outlined in the Best Start in Life work plan and alignment to the national Start for Life programme delivered through the Family Hubs (for copy of report, see file of Minutes).

Julia Bates, Consultant in Public Health was in attendance to deliver a presentation that provided details of the Context; 1001 Critical Days; Priorities; Speech Language and Communication; Unintentional Injuries; Perinatal & Infant Mental Health; Breastfeeding; Tobacco Dependency in Pregnancy; Supporting Vulnerable Families; Improve Health Weight and Recommendations (for copy of presentation, see file of Minutes).

Reference was made to the development of a Perinatal and Infant Mental Health Strategy which will go out for public consultation in early 2024 for 6 weeks and members expressed their desire to engage in the process.

Mrs Gunn referred to the consultation in the New Year and commented that previous consultations’ results had seen a poor uptake and the number of people the consultation was reaching was relatively low as a proportion of the County’s population. She stated that it was important to effectively plan before the consultation goes ahead to reach as many people as possible. She then referred to smoking and asked if they had statistics of how many pregnant women had given up smoking before getting pregnant or during pregnancy to see what impact it was having relative to the population and if this also included vaping.

The Consultant in Public Health referred to the Perinatal and Infant Mental Health Strategy consultation and agreed that when there was a public consultation often there was not a significant response. She continued that the service would be carrying out some significant work to ensure clear questions and working with colleagues for opportunities to share across a number of channels.  This would include the Parent Carer Panel link to the Family Hubs who were involved with developing the strategy and they may have the opportunity to consult with key groups.

In terms of smoking, she did not have the data to hand on women who present as smokers then give up but evidence suggested that women spontaneously give up smoking when they become pregnant but there remains a high number of women who are smoking at the time of delivery. There was no data for women who ceased smoking without accessing services or immediately on finding out they were pregnant. The Consultant in Public Health committed to come back with information on women who quit having come into services because they were a smoker during pregnancy. She stated that vaping was a different issue in that whilst vaping was not without risk including during pregnancy, it was a significantly lower risk than smoking in pregnancy. Whilst not recommending that anyone starts vaping who was not a current smoker, for current smokers the service would recommend a switch to vaping. She had some information around vaping in pregnancy and appreciated it was a topic of concern but vaping did not include some of the harmful chemicals in cigarettes. There was current research suggesting that e-cigarette use was as safe as NRT patches and a more effective treatment option.

Councillor Walton referred to working with Family Hubs to get the information out and asked if the service work with other community organisations as she felt there was a lot of people who would benefit from this information who do not access the Family Hubs.

The Consultant in Public Health asked if she could come back to Councillor Walton following the presentations on Family Hubs.

Councillor Lines referred to speech, language and communication in the first 1001 days and was conscious that in conditions like autism and ADHD there was a broad spectrum of how that manifests itself which could make a confident diagnosis difficult at that early age. However, getting it wrong can send a child along the wrong treatment and support pathway with potential serious implications when they get older. He continued that it was vital to do the work that was been undertaken in the first 1001 days but was interested to learn what happens to regular review the circumstances with each child to ensure they were getting the most appropriate support for their particular case.

The Consultant in Public Health responded in terms of the speech, language and communication that there were opportunities for Health Visiting services to identify need and what was relatively new was the early language identification measure that identifies the speech and language need but not necessarily the reason for that need but would ensure appropriate referral to services. She continued that families have access to their GP, Health Visiting Service and specialist services if referred, as work goes on to address the needs of the child with the family. She stressed that it was not always possible early on to identify necessarily the reason for the speech and language and communication issues but identify that support was required which would result in an appropriate referral to services.

Councillor Scurfield thanked the officer for an informative presentation and referred to feedback provided to her when talking to local primary schools was that a child’s readiness for school was a concern for them and asked why this was not one of their priorities. She then referred to the additional provision for the enhanced pathway and asked for more detail on this provision. In terms of the Healthy Start Vouchers she asked for details of the eligibility criteria for the vouchers.

The Consultant in Public Health responded in terms of school readiness the focus of the Best Start in Life Steering Group was up until the child was two and a half years old. They worked closely with early years education colleagues and one area was to try and encourage a good uptake of the nursery placement provision for two-year-old offer, particularly to low-income families. Whilst take up data could be sourced, she was confident that the uptake of that offer was good. By engaging in early education and having access to a suitable early year’s place, this would support children in terms of school readiness. The enhanced parent support pathway provided access to more Early Health support from the Health Visiting Service tailored to meet the needs of the individual family. In respect of the Healthy Start Vouchers, she explained that the vouchers were for low-income families and she the relevant accessibility criteria could be circulated to Members. Some marketing information for the initiative had been developed and this could also be circulated as it was great to promote in communities.

Professor Ciesielska referred to breastfeeding support groups being offered and asked if access to individual breastfeeding or lactation consultations was available or being considered.

The Consultant in Public Health indicated that there was more detail on this in the Annual 0-25 Family Health Service Update so would pick up this question following that presentation.

Councillor Hunt asked if pregnant women got priority for the smoking cessation services.

The Consultant in Public Health responded that in terms of stop smoking services there was now a specialist tobacco treatment in pregnancy service which was within Durham and Darlington NHS Foundation Trust that was working with midwifery services in terms of supporting pregnant women to quit smoking. The community stop smoking service was available also for family members and pregnant women had access to the service. In response to a further query she indicated that she was not aware of a waiting list for this service but would confirm this information and get back to Members.

Councillor Coult referred to breastfeeding and reference to the local insight work undertaken to better understand the barriers and asked when this would be available. She then referred to vaping and members ongoing concerns around vaping take up within County Durham. She indicated that not enough was known around the risks associated with vaping and that more information was needed.

The Consultant in Public Health responded that the breastfeeding insights work had been undertaken and the analysis of that was not yet available. She confirmed that the findings could be shared with members when analysed. With regard to vaping she stated that vaping was significantly less harmful than smoking and there was currently a lot of concerns around youth vaping. In terms of taking a risk reduction approach, pregnant women who were current smokers should be advised to stop smoking, use nicotine replacement therapy or use a vape due to the significant known risks of harm to the baby in pregnancy and to families from second hand smoke. She stated that they needed to work with the current science and understanding and was what they were doing in partnership as best as they could.

Councillor Varty referenced the local and national challenges being experienced in terms of shortages of health visitor staff and also high staff turnover rates. This was a particular challenge for young mothers who often expected access to the same health visitor and often struggled to understand why staffing personal changed. Councillor Varty suggested that these issues should be communicated to young mothers as soon as possible.

The Consultant in Public Health indicated that there was a presentation on the 0-25 Family Health Service and Family Hubs and would answer any questions following the presentation.

Resolved: That the contents of the report and presentation be noted and the Committee promote the opportunities to work collaboratively and further explore opportunities to meet the needs of children and young people as early as possible.