JSNA Start Well

1. Introduction

Our earliest experiences of life, starting in the womb, through pregnancy and birth and into our early years, are vital in laying the foundations for our future health and well-being. Research consistently shows that even short-term improvements in physical, cognitive, behavioural, social and emotional development can lead to benefits throughout childhood and later life.

The Marmot Review, Fair Society, Healthy Lives identified giving every child the best start as the highest priority in reducing the inequalities gap that exists between different groups of people. Action to reduce health inequalities needs to start before birth and be followed through the life of the child to improve adult health outcomes. The Healthy Child Programme, concentrated on pregnancy and the first five years of life, sets out an integrated approach to improving the health and well-being of children and supporting families, and sets out recommended standards for service delivery 1. Improving health and well-being outcomes and reducing health inequalities is a major focus for interventions around pregnancy and maternal health, early years, and children and young people in Wandsworth.

1.1 Key Demographics and Need

  • In Wandsworth 17.4% (n=57,783) of the total population are under 18 in 2023, with a third of all households containing children 2.

  • The population of 0–17-year-olds is projected to decrease by 9.6% by 2041 (from 57,783 in 2021 to 52,257 in 2041) 3.

  • 17.2% of children aged under 16 years live in poverty in Wandsworth, 4.1/1000 families are classed as homeless which is worse than both London and England.

  • In 2020, 45% of children and young people in Wandsworth were from a Black Asian and Minority Ethnic.

  • Black Asian and Minority Ethnic groups are often disproportionately affected by poor health outcomes across a number of domains related to deprivation, language (English as a first language), housing and health inequalities.

  • In 2018, there was a higher proportion of children with special needs attending Wandsworth schools (17.3%, n=5,821) compared with the rest of London (14.4%), and England (14.4%).

  • Educational attainment overall in Wandsworth is better than average. However, the achievement of some groups is well below the average. For instance, 76.3% of children have reached a good level of development by the end of Reception, but the equivalent figure for children on free school meals is 59.9% (broadly similar to the England average for this group).

1.2 Indicators of Health and Well-being

  • Indicators of population health and well-being among children and young people in Wandsworth are either better or similar to the England average. The infant and child mortality rate is an indicative measure of overall health and in Wandsworth this rate fares well (infant 1.9/1000, child 7.8/100,000 population) against London (infant 3.9/1000, child 9.8/100,000 population) and national averages, England (infant 3.9/1000, child 10.3/100,000 population)

  • The prevalence of obesity also increases more than two-fold between Reception (9.8%) and Year 6 (22.3%) (2021/22). Levels at Year 6 are better than London (25.8%) and national (23.4%) averages.

  • Less than 95% (the minimum recommended coverage level) of children have received their first dose of all key childood immunisations, including mumps, measles and rubella (MMR). By the age of five, only 87.5% of children have received their second dose of the MMR vaccine.

  • The percentage of school pupils with social, emotional, and mental health needs in Wandsworth at 3.9% was higher than both London and England levels (2.7% and 3.0% respectively).

2. Population

2.1 Demographics

For latest demographic information please go to the population explorer on DataWand.

Under 18s Population Pyramid

In Wandsworth in 2024, 17.0% (n=56,945) of the total population are under 18 years old. The proportion of children in the borough is 17.3% lower than the London average of 20.6%.

The population of 0–17 year olds is projected to decrease by 9.6% by 2041 (from 57,783 in 2021 to 52,257 in 2041).

Source: © GLA 2021-based demographic projections. Housing-led population projections. Past Delivery 10-year migration, 2023

Under 18s Ethnicity Breakdown

In Wandsworth in 2024, 45.3% (n=30,958) of the total population aged under 18 were from BAME ethnic groups. The proportion of children from BAME ethnic groups in the borough is 20.8% lower than the London average of 57.2%.

Source: © GLA 2016-based Demographic Projections, 2017

2.2 Childhood Mortality Rates

Infant Mortality

Comparing local indicators with England averages, the health and well-being of children in Wandsworth is better than England. The infant mortality rate is better than England, but an average of 11 infants die before the age of 1 each year.

Infant mortality is an indicator of the general health of an entire population. It reflects the relationship between the causes of infant mortality and upstream determinants of population health such as economic, social, and environmental conditions. Deaths occurring during the first 28 days of life (the neonatal period) in particular, are considered to reflect the health and care of both mother and new-born.

Infant mortality rate: In 2020 - 22, Wandsworth’s rate was 1.9 per 1,000 (n=23), which was the lowest in London, 52.4% lower than the England average and 46.1% lower than the London average. The latest Borough figure for 2020 - 22 was also 46.2% lower than in 2001 - 03, in comparison with 26.5% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Mortality in 1-17 year olds

Child mortality rate (1-17 years): In 2020 - 22, Wandsworth’s rate was 10.5 per 100,000 (n=17), which was the 10th highest in London, 0.9% higher than the England average and 13.1% higher than the London average. The latest Borough figure for 2020 - 22 was also 3.5% higher than in 2010 - 12, in comparison with 16.7% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

2.3 Education of School Aged Children

Learning ensures that children develop the knowledge, understanding, skills, capabilities, and the attributes they need for mental, emotional, social and physical well-being now and in the future. Access to a good education increases the prosperity of young people in the type and level of employment they can secure as they enter adulthood. Children affected by emotional disorders are more likely to have lower educational attainment, live in poverty, self-harm and be a perpetrator and/or victim of crime.

School Population

Wandsworth has 118 schools, three are state funded nurseries, 62 are state funded primaries, 11 are state funded secondaries, seven are state funded special schools, three are pupil referral units, and 32 are independent schools. The schools provide education to approximately 45,000 pupils within the borough (2020 data). 46% of pupils attended state funded primary schools, 29% attended state funded secondary schools, and 23% attended independent schools. The remainder attended state funded nursery, special schools, and pupil referral units (PRUs). A much higher proportion of local students attend independent schools compared with London 10% and England 6%4 . In Wandsworth, 91% of primary school pupils attended state funded schools which was similar to the London rate of 92%, but lower than the England rate of 96%. 72% of secondary school age pupils attend state-funded schools which was lower than the London and England rates of 79% and 91% respectively.

Source: GOV.UK. School, pupils and their characteristics. January 2020

Attainment

Educational attainment in Wandsworth is broadly higher across school phases up to and including GCSE. Table 3 shows Wandsworth’s educational attainment in comparison to the London and England averages. Average point scores at Key Stage 5 for both A Levels and applied general (a form of vocational qualification) are below national and London averages. Locally, the rate of pupil absence is lower than London and England.

  • KS4 and KS5 are teacher assessment grades in 2020

Achievement in 2019 at the Early Years Foundation Stage for those from Black, Asian and Minority Ethnic backgrounds was lower than the borough average of 76%. The Black Ethnic group had the lowest level of attainment, 10% below the borough average. Achievement for this group was also below the national average, 66% compared with a 68% nationally.

In 2020, the number of pupils attending Wandsworth state schools and independent schools with special educational needs and disabilities (SEND) was 8,000 (17.8%). This was higher than London and England rates of 15.0% and 15.4% respectively. Locally, the proportion of pupils with SEND in Wandsworth schools has remained around 13% of the school population. The borough rates have been higher than the London and England rates since 2014. Wandsworth is the 4th highest borough nationally where pupils with SEND are attending Wandsworth schools but live in other local authorities (34.4%).

Variations also exist between datasets in terms of the categorisation of needs, consideration of primary or multiple needs, and when known to multiple services. This can make it difficult to map trends in access to and provision of services across the population of children and young people. Furthermore, care is required when interpreting data to ensure that a consistent population is used for comparison.

Local authorities do not have a remit to record any attainment or destination data for young people who are home educated meaning comparisons with mainstream school performance measures cannot be discerned. Wandsworth is working towards establishing a dataset for understanding the post-16 destinations of Elective Home Educated (EHE) children.

2.4 Child Poverty

The Marmot Review (2010) suggests there is evidence that childhood poverty leads to premature mortality and poorer health outcomes for adults. There is also a wide variety of evidence to show that children who live in poverty are exposed to a range of risks that can have a serious impact on their mental health. Reducing the number of children who experience poverty should improve their health outcomes in adulthood and increase their healthy life expectancy.

Children in Low Income Families

The level of child poverty in Wandsworth is similar to England, with 17.2% (8465) of children aged under 16 years living in low-income families 4.

Children in absolute low income families (under 16s): Absolute low income is defined as a family in low income Before Housing Costs (BHC) in the reference year in comparison with incomes in 2010 to 2011. A family must have claimed one or more of Universal Credit, Tax Credits or Housing Benefit at any point in the year to be classed as low income in these statistics.

Absolute low income takes the 60 percent of median income threshold from 2010 to 2011 and then fixes this in real terms (i.e. the line moves with inflation). This is designed to assess how low incomes are faring with reference to inflation. It measures the number and proportion of individuals who have incomes below this threshold. The percentage of individuals in absolute low income will decrease if individuals with lower incomes see their incomes rise by more than inflation.

In 2022/23, Wandsworth’s rate was 9.7% (n=5151), which was the 8th lowest in London, 37.8% lower than the England average and 21.1% lower than the London average. The latest Borough figure for 2022/23 was also 9.0% higher than in 2014/15, in comparison with 1.3% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Free School Meals

In Wandsworth in 2019 there were 6,072 pupils, including those attending special schools, pupil referral units and local authority alternative provision, known to be eligible and claiming free school meals (FSM). Among those attending state funded schools, 24.3% (n=64) of nursery pupils, 17.2% (n=3,570) of primary school pupils and 16.6% (n=2,093) of secondary school pupils were eligible for and claiming FSM. A much higher proportion of nursery school pupils claim FSM (24.3%), in comparison to London (10%), inner London (12.7%) and England (6.6%).

The number of children known to be eligible for FSM is frequently used as an indicator or poverty. In Wandsworth, 19.6% (6,761) of pupils, including those attending special schools, pupil referral units, and local authority alternative provision, were known to be eligible for and claiming FSM in January 2020. This was similar to the London average of 18.8% but below the England figure of 17.3%. This has increased in each of the last two years. Of those attending state funded schools 25.9% (n=58) of nursery pupils, 19.2% (n=3,922) of primary school pupils, and 18.5% (n=2,400) of secondary school pupils were eligible for and claiming FSM. A much higher proportion of state-funded nursery school pupils claim FSM locally (25.9%) compared to London (10.1%), and England (6.7%) 5.

Children on FSM achieving a good level of development at Reception is much lower at 60% and, while improvements have been made since 2012/13, there are early signs that these improvements are beginning to decline.

The number of children known to be eligible for free school meals is frequently used as an indicator or poverty.

Free school meals: % eligible: In 2022/23, Wandsworth’s rate was 27.8% (n=9236), which was the 14th highest in London, 16.6% higher than the England average and 7.6% higher than the London average. The latest Borough figure for 2022/23 was also 10.4% higher than in 2011/12, in comparison with 41.4% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

3. Prenatal and Postnatal Health

Many of the health behaviours and risk factors for poor birth outcomes are established prior to pregnancy. Often there is limited potential to impact on these after conception (the start of pregnancy) 6. For example, 13.7% of adult women smoke and whilst few, if any, take up smoking as a new behaviour while pregnant, in the UK 11% of women are still smoking through to the birth of their baby.

3.1 Healthy Behaviours in Pregnancy

A mix of health-related behaviours, reducing risk factors, and supporting women to alleviate the negative impact of the wider determinants on their health, will enable them to have a healthy pregnancy. Even among those who do plan their pregnancy, relatively few will modify their behaviours 7.

Healthy behaviours include a healthy diet (including folic acid supplements), regular physical activity, and emotional well-being. It is important immunisations, sexual health checks, and smear tests are up to date.

Pre-conception risk factors include smoking, alcohol, substance misuse, obesity, long term physical and mental health conditions, previous pregnancy complications, genetic risks, maternal age, adverse childhood experiences (ACEs), domestic violence, and migrant health factors 8 and these will often be interlinked.

Furthermore, the wider determinants of health such as housing, education and skills, financial security, work, and family relationships also influence pre-conception health. The impacts of these are unequally distributed meaning those with the greatest need may have the most difficulty accessing care. Many of these issues are covered across the whole of the JSNA and will be referenced elsewhere. Only a snapshot of health behaviours and risks factors for Wandsworth will be covered in this chapter.

Women who are overweight or obese before pregnancy have increased risk of infertility. They may also be complications during pregnancy and birth including impaired glucose tolerance/gestational diabetes, miscarriage, preeclampsia, thromboembolism, and maternal death. Babies born to obese women have a higher risk of foetal death, stillbirth, congenital abnormality, shoulder dystocia, macrosomia, and subsequent obesity. In 2016/17 over 55% of women were overweight or obese in England and the prevalence of overweight and obese adults is predicted to reach 70% by 2034.

Some pre-existing conditions such as epilepsy or severe mental illness can be a risk factor for maternal deaths either within pregnancy or for up to a year after the end of the pregnancy. Maternal suicide 9 remains the leading direct cause of maternal deaths. Nationally 1 in 7 women die in the period between six weeks and one year after pregnancy by suicide. Nationally, an estimated 20% of women will develop a mental illness during pregnancy or within the first year after having a baby. It is estimated in Wandsworth that during this time :

  • 358 to 537 women will develop mild to moderate depressive illness and anxiety
  • approximately 537 to 1073 women will develop adjustment disorders and distress
  • 107 women will have post-traumatic stress disorder
  • 107 women will have a severe depressive illness
  • 7 women will be living with a chronic serious mental illness
  • 4 women will be affected by postpartum psychosis.

Maternal age is a factor that can influence both pregnancy and childhood outcomes. Teenage pregnancy is associated with a higher risk of late antenatal booking, lower birth weight babies, stillbirth, and infant mortality. The rate of under-18 years conceptions in Wandsworth has seen a substantial reduction over the last decade and has fallen more steeply than those across England 10. The latest data for 2021 shows that in England 13.1/1,000 young women under-18 years became pregnant.

Births to women aged 35 years and over also carry additional risks in relation to birth complications, congenital abnormalities, stillbirth, and emergency sections. However, the exact age at which these risks increase is uncertain and co-existence of additional risk factors e.g., smoking, will increase the chance of adverse birth outcomes. The latest Office of National Statistics (ONS) conception data released in 2021 indicates that between 2011 and 2021, women aged 35 to 39 years and aged 40 years and over, were the only age groups to see an overall increase in conception rates. Since 2011, the conception rates have increased by 3.5% for women aged 35 to 39 years and 19.7% for women aged over 40 years 11. Nationally, women are progressively delaying childbearing until older ages. The latest available data shows that 8% of births in Wandsworth were to women aged 40+, which ranks the seventh highest in London and is above the England percentage of 4.4%.

Trends in outcomes for new-borns may reflect the higher maternal age in Wandsworth:

  • the percentage of births delivered by caesarean section are statistically similar at 28.3% for women in Wandsworth and across England at 27.1%, and has increased minimally since 2014
  • the stillbirth and neonatal mortality rate at 5.7/1000 live births is statistically similar to England at 6.9/1000, with no discernible increase or decrease in trends
  • while low birth weights of babies are higher than the England average, very low birth weight of all babies at 0.93% is statistically similar to England at 1.14%, with no discernible increase or decrease in trends
  • the premature birth rate (births at less than 37 weeks) at 69.5/1000 live births is statistically better than England at 81.2/1000 births, with no discernible increase or decrease in trends.

3.2 Smoking in Pregnancy

Smoking is the single biggest modifiable risk factor for poor birth outcomes. Smoking during pregnancy causes up to 2,200 premature births, 5,000 miscarriages and 300 perinatal deaths every year in the UK. It also increases the risk of stillbirth, complications in pregnancy, low birthweight, and of the child developing other conditions in later life. Currently 13.7% of adult women in the UK smoke cigarettes and nearly 11% of women in England are still recorded as smoking at the time of delivery.

Smoking in Early Pregnancy

Smoking in early pregnancy: In 2018/19, Wandsworth’s rate was 3.1%, which was the 3rd lowest in London, 75.9% lower than the England average and 48.9% lower than the London average. Time series data were not available for this indicator.

Source: OHID: Public Health Profiles

Smoking in Late Pregnancy

Smoking status at time of delivery: In 2022/23, Wandsworth’s rate was 5.2% (n=159), which was the 8th highest in London, 40.9% lower than the England average and 13.0% higher than the London average. The latest Borough figure for 2022/23 was also 18.3% higher than in 2010/11, in comparison with 35.5% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

3.3 Low Birthweight

Low birthweight (under 2.5kg) is one of the known risk factors for infant deaths.

Low birth weight of term babies: In 2021, Wandsworth’s rate was 2.8% (n=106), which was the 11th lowest in London, 1.3% higher than the England average and 14.7% lower than the London average. The latest Borough figure for 2021 was also 36.3% higher than in 2006, in comparison with 8.1% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

3.4 Breastfeeding

The first 1001 days mark the moment of conception through to a child’s second birthday and have been found to be crucial for laying the foundations for future development and preventing illness in later life.

Ensuring every child has the best start in life is a national and a local priority. Initiating breastfeeding from birth is one of the earliest interventions that can give a child the best possible start, can lay the foundations for future development, and prevent illness in later life. Initial breastfeeding uptake 12 in Wandsworth has seen increases in recent years, and currently stands at 86.7%, which is the third highest in London. Whilst this is encouraging, the child poverty indicators suggest that more needs to be done to ensure early health gains are sustained as children develop.

The World Health Organisation (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) recommend breastfeeding to be initiated within the first hour after birth and continued exclusively for the first six months and beyond with safe weaning onto solids foods. The UK, however, has one of the lowest breastfeeding rates in the world. There is limited breastfeeding data available to compare trends particularly due to the different timescales for data collection internationally.

An analysis of global breastfeeding prevalence in 2016 found that only 34% of babies in the UK were receiving breastfeeding at six months compared with 49% in the US, and 71% in Norway 13. Additionally, a study based on 73 countries between 2010–2017 on breastfeeding at 2 years showed the length of time a mother breastfed was associated with the socioeconomic status of the household. Furthermore, 64% of babies in poor families were still breastfeeding at two years, in line with WHO recommendations, when compared with 41% of babies from the richest families. The gap was widest in West and Central Africa with 63% of babies from the poorest families breastfeeding at two years of age. In Eastern Europe and Central Asia between the wealthiest and poorest families there were low rates of breastfeeding at 2yrs at 23% for the wealthiest families and 31% for the poorest 14.

There are multiple explanations for these low breastfeeding rates. Sometimes mothers experience practical problems when establishing breastfeeding and fail to receive adequate practical support. There are additional concerns about whether a child is receiving sufficient milk, and is often due to advice from friends, family and professionals to supplement with formula milk. This reduces breastmilk production and is strongly associated with premature cessation of breastfeeding 15. Anecdotal evidence reveals that social attitudes about women breastfeeding in public may lead to women feeling uncomfortable about breastfeeding.

In light of these low figures, there are several policy drivers in the UK promoting breastfeeding which include (but are not limited to):

  • Healthy Child Programme 2009 – pregnancy & the first 5 years of life
  • UNICEF Baby Friendly Initiative
  • Public Health Outcomes Framework
  • Public Service Agreements (PSA) targets such as reducing infant mortality rate & preventable infections, reducing hospital admissions in infancy, and reducing childhood obesity.

Increasing the number of babies breastfed ensures they have the best possible start with significant health benefits for both mother and baby. For the baby this includes protection against illness and infection, prevention of diarrhoea and respiratory infections, reduced risk of sudden infant death syndrome (SIDS), and risk of breast cancer, postnatal depression, and ovarian cancer for the mother 16.

Breastfed children also perform well on intelligence tests and are less prone to diabetes in later life. There is also growing evidence to suggesting an increased future risk of childhood obesity in those who have not been breastfed. In addition to the health benefits of breastfeeding, a cost/benefit analysis carried out by UNICEF, indicates increasing the number of babies who are breastfed will help save the NHS up to £50 million each year 17 thereby reducing financial pressure on both local and national resources.

Breastfeeding Rates

Baby’s first fed breastmilk is defined as the percentage of babies whose first feed is breastmilk which includes expressed and donor milk. This first fed breastmilk is important for two reasons:

  • the establishment and continuation of breastfeeding begins with initiation and first feed
  • the feeding of colostrum in the first hours and days of life confers protective benefits.

Colostrum contains several concentrated properties which provide a protective coating to the lining of the gut preventing bacterial transfer. The percentage of babies first fed breast milk in Wandsworth is among the top three boroughs in London, higher than London and England averages.

Baby’s first feed breastmilk (previous method): In 2018/19, Wandsworth’s rate was 86.7% (n=3615), which was the 3rd highest in London, 28.7% higher than the England average and 13.6% higher than the London average. The latest Borough figure for 2018/19 was also 9.7% higher than in 2017/18, in comparison with nan% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Breastfeeding initiation (within the first 48 hours of birth) and uptake at 6–8 weeks are included in the National Institute for Health and Clinical Excellence (NICE) proposals for the Commissioning Outcomes Framework.

Breastfeeding prevalence at 6–8weeks is defined as the percentage of infants that are totally or partially breastfed at age 6–8 weeks.

Table below shows that Wandsworth has seen an overall improvement in 6–8 week prevalence rates between 2018 to 2019 from 26% in quarter 1 to 79% in quarter 4. The overall total for the year is 56%, higher than the England average. Breastfeeding prevalence at 6–8 weeks for Wandsworth in quarter 1 and quarter 2 was lower than the England average. However, this was due to a change in systems nationally and locally resulting in staff recording errors which have now been resolved.

Source: England data source 18 CLCH 19 for Wandsworth

Since April 2003, data on the local breastfeeding prevalence at 6–8 weeks has been requested on a quarterly basis. Historically this was obtained from all Primary Care Trust (PCTs), via the Department of Health (DH), Integrated Performance Monitoring Returns. Between April 2013 and September 2015 data was collected directly from providers via the data collection tool that is part of Unify2, a web-based system set up to collect performance and other central returns directly from the NHS. From October 2015 the breastfeeding data set has been obtained from the health visiting service at a local authority level. There is a national programme to strengthen the breastfeeding data collection system to ensure accuracy and timeliness of data submission.

Breastfeeding coverage is defined as the percentage of maternities for whom breastfeeding initiation status is recorded. For breastfeeding prevalence data to meet statistical requirements and be validated, the coverage for both initiation and 6–8 weeks must be at least 95% 20. Wandsworth has not met this target and for this reason these indicators have not been updated for a few years nationally. Going forward, Wandsworth will have regular local data allowing to monitor trends in breastfeeding rates.

There are a range of breastfeeding services on offer in the community and in the hospital. Public Health Wandsworth, commission Central London Community Healthcare Trust (CLCH) to provide the Health Visiting Service for Wandsworth’s young adults. This includes providing evidenced pathways for delivering each of the 6 High Impact Areas to all levels of family need. The High Impact Areas are part of the 4-5-6 Model which provides an evidence-based framework through which health visitors can maximise their contribution was leaders of the Healthy Child Programme.

Breastfeeding support for Wandsworth is provided by the Health Visiting Service and supported by infant feeding leads in hospital and in the community:

  • Hospital: Women receive breastfeeding support from the day of their child’s birth, if they choose to breast feed, until around day 10 – 28 days. The handover of support to the Health Visiting Service commences from day 10 after birth. The midwives in the hospital are trained to provide baby-friendly standard care by the Infant Feeding Team. Additionally, St George’s Hospital have a Breastfeeding Peer Support Scheme, which includes Breastfeeding Peer Supporters, who support the midwives to provide mothers with breastfeeding support where needed. This team is managed by the hospital’s Infant Feeding Lead.

  • Community: The community infant feeding lead delivers training for the health visitors, who provide breastfeeding support to mothers when they are discharged from the Community Midwife Team, usually between 10 to 14 days after the birth. Breastfeeding Support Clinics are available around the borough to support mothers as needed and they are led by the Health Team’ made up of health visitors, nursery nurses and lactation consultants. Additionally, there are voluntary independent organisations that run Breastfeeding Support Groups within the Borough led by La Leche League Leaders and Nation Child Trust (NCT) breastfeeding counsellors.

Wandsworth Council has a Breastfeeding Operational Group chaired by the Public Health Children and Young People Lead. Members of the group include the infant feeding leads for both the hospital and community, breastfeeding lactation consultants from the voluntary sectors, health visitors and Children’s Services.

Wandsworth Health Visiting Service currently has Level 1 UNICEF Baby Friendly Initiative Accreditation. Central London Community Healthcare is currently going for Level 2 status. A key element of this is supporting families with feeding and ensuring all children get the best start in life. Whenever possible this is supporting breastfeeding and appropriate formula feeding where necessary.

Wandsworth has a Breastfeeding Welcome Scheme that encourages businesses and organisations to display posters to support mothers to breastfeed on their premises.

UNICEF Baby Friendly Initiative Accreditation

UNICEF Baby Friendly Accreditation is an evidence based, staged accreditation programme that supports Maternity, Neonatal, Health Visiting and Children’s Centre Services to deliver effective breastfeeding support. It is a nationally recognised mark of quality care for babies and mothers. In Wandsworth the Infant Feeding Leads for both the community and the hospital (St George’s Maternity) lead on this programme. To date the hospital has achieved Level 3 (full accreditation) and is in the process of reaccreditation to maintain full accreditation status of the programme. The community service has just been assessed for Level 2 and are awaiting final results. While this was due to commence during 2020 all accreditation programmes were paused due to COVID-19. Reassessment for Stage 2 is now planned for the end of 2021 with the view to achieving Baby Friendly Initiative stage 3 accreditation by the end of 2022.

UNICEF Baby Friendly Initiative
UNICEF Baby Friendly Initiative

Source: UNICEF UK. Baby Friendly Initiative. 2020 (redesigned internally)

There are a range of evidence-based approaches to promoting breastfeeding in the UK. Some of these have been implemented in Wandsworth. There is overwhelming evidence that shows breastfeeding saves lives. “Breastfeeding practices are highly responsive to interventions delivered in health systems, communities and homes. The largest effects are achieved when interventions are delivered in combination” (Lancet Breastfeeding Series, 2016).

Public Health in Wandsworth is working with the National Childbirth Trust to create baby friendly places that promote breastfeeding in public space. The programme includes the development of resources (posters, stickers, leaflets) for local businesses, GPs, libraries, and other community settings to support their commitment to promote breastfeeding in their settings. Promotional material provides mothers with information on breastfeeding friendly places across the borough. Discussions are also in place to develop a ‘breastfeeding peer support service’ in the community with a timeline to achieve Level 3 (full accreditation) within 1 year of achieving Level 2 accreditation for the Peer Scheme.

Wandsworth, currently, has some of the recommended breastfeeding initiatives in place and is working towards implementing a more robust multi-faceted and evidence-based approach.

4. Antenatal and Newborn Screening

4.1 Newborn Blood Spot Screening

All babies up to, but not including, their first birthday are eligible for the Newborn Blood Spot Screening (NBSS), otherwise known as the ‘heel prick test’. The aim of the screening programme is to enable early identification, referral, and treatment of babies with nine rare but serious conditions, the last six of which are inherited metabolic diseases, including:

  • sickle cell disease
  • cystic fibrosis
  • congenital hypothyroidism
  • phenylketonuria
  • medium-chain acyl-CoA dehydrogenase deficiency
  • maple syrup urine disease
  • isovaleric acidaemia
  • glutaric aciduria type 1
  • homocystinuria.

A health professional will usually take a blood spot sample on day 5 (day of birth is day 0) from a child’s heel and send the sample for testing. Babies, who are new to the country or are yet to have a blood spot test, are eligible for testing up to one year old. Data for Wandsworth has not been available for the last four years. The latest available data for the borough was 2015/16 and the coverage or the blood spot screening was 99% of all newborns.

In 2018/19 99.4% of babies registered with Wandsworth Clinical Commissioning Group (CCG) GPs that were eligible for NBS screening had a conclusive result recorded on the Child Health Information System (CHIS) at less than or equal to 17 days of age. Furthermore, 94.4% of those who either moved in from a different CCG area in the first year of life, or moved in from another UK country or abroad, had a conclusive result recorded on the CHIS at less than or equal to 21 calendar days of notification of the CHRD.

4.2 Newborn Hearing Screening

Newborn hearing tests help to identify most babies with significant hearing loss. The hearing screening significantly reduces the risk of having undiagnosed hearing problems that can affect children’s speech and social development 21.

Newborn Hearing Screening: Coverage: In 2022/23, Wandsworth’s rate was 98.7% (n=3862), which was the 16th lowest in London, 0.2% higher than the England average and 0.1% higher than the London average. The latest Borough figure for 2022/23 was also 0.9% higher than in 2013/14, in comparison with 0.1% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

5. NHS Childhood Vaccination Programmes

Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases. Coverage is closely correlated with levels of disease. Monitoring coverage identifies drops in levels of population immunity before the levels of disease rise.

5.1 Routine Pre-School Immunisations

Immunisations for vaccine-preventable diseases including congenital rubella syndrome, pertussis, influenza, and hepatitis B infection are an important element of protecting the health of mother and baby. Maternal rubella infection in pregnancy, for example, may result in foetal loss or congenital rubella syndrome, and influenza infection in pregnancy is associated with risks to the foetus, including stillbirth.

The complete childhood vaccination schedule covers numerous diseases. In addition to whole population vaccinations the schedule also includes additional vaccinations for at risk groups such as annual influenza for babies born to hepatitis B infected mothers, and infants in areas of the country with high tuberculosis rates. Additional vaccines are also given to individuals with underlying medical conditions. To achieve community immunity to the disease, the required coverage for the childhood vaccinations is 95% of the eligible population.

DTaP/IPV/Hib

The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against diphtheria, pertussis (whooping cough), tetanus, haemophilus influenzae type B (an important cause of childhood meningitis and pneumonia), and polio (IPV is inactivated polio vaccine).

The vaccine is offered when babies are two, three and four months old. Monitoring coverage identifies drops in population immunity before levels of disease rise. The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against these five diseases.

Population vaccination coverage: Dtap IPV Hib HepB (1 year old): In 2022/23, Wandsworth’s rate was 89.9% (n=3731), which was the 10th highest in London, 2.1% lower than the England average and 2.7% higher than the London average. The latest Borough figure for 2022/23 was also 1.4% lower than in 2010/11, in comparison with 2.5% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Population vaccination coverage: DTaP and IPV booster (5 years): In 2022/23, Wandsworth’s rate was 66.8% (n=2863), which was the 6th lowest in London, 19.8% lower than the England average and 8.1% lower than the London average. The latest Borough figure for 2022/23 was also 6.1% lower than in 2015/16, in comparison with 3.4% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Measles, Mumps and Rubella (MMR) vaccinations

MMR is the combined vaccine that protects against measles, mumps and rubella which are highly infectious, common conditions that can have serious complications, including meningitis, swelling of the brain (encephalitis) and deafness. They can also lead to complications in pregnancy that affect the unborn baby and can lead to miscarriage.

The first MMR vaccine is given to children as part of the routine vaccination schedule, usually within a month of their first birthday. They will then have a booster dose before starting school, which is usually between three and five years of age.

MMR vaccine coverage across London and England had been falling between 2013/14 and 2018/19 for all ages and for both doses since the previous period.

Population vaccination coverage: MMR for one dose (2 years old): In 2022/23, Wandsworth’s rate was 83.7% (n=3312), which was the 16th highest in London, 6.3% lower than the England average and 1.6% higher than the London average. The latest Borough figure for 2022/23 was also 1.6% higher than in 2010/11, in comparison with 0.2% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Population vaccination coverage: MMR for two doses (5 years old): In 2022/23, Wandsworth’s rate was 75.2% (n=3221), which was the 15th highest in London, 11.1% lower than the England average and 1.6% higher than the London average. The latest Borough figure for 2022/23 was also 13.3% lower than in 2010/11, in comparison with 0.4% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

5.2 School Age Immunisations

Human Papillomavirus Vaccinations (HPV)

Some types of Human Papillomavirus Virus (HPV) are linked to the development of cancers, such as cervical cancer (more than 70% of these cancers are linked to HPV), anal cancer, genital cancers, and cancers of the head and neck. Two doses of HPV vaccine protect against four types of HPV: 6, 11, 16 and 18. Type 16 and 18 significantly increase the chances of developing cancer.

The 1st dose of the HPV vaccine was routinely offered to girls aged 12 and 13 years in school, with the 2nd dose offered usually within one year from the first dose. For school year 2019/20 boys and girls in Year 8 are eligible for the HPV vaccine 22.

Population vaccination coverage: HPV vaccination coverage for two doses (13 to 14 years old): In 2022/23, Wandsworth’s rate was 54.8% (n=692), which was the 16th lowest in London, 12.9% lower than the England average and 3.7% higher than the London average. The latest Borough figure for 2022/23 was also 34.6% lower than in 2015/16, in comparison with 26.1% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Meningococcal (MenACWY) Vaccinations

MenACWY vaccine protects against four strains of the Meningococcal bacteria – A, C, W, Y – which cause meningitis and blood poisoning (septicaemia). Children aged 13 to 15 are routinely offered the MenACWY vaccine in schools 23.

Population vaccination coverage: Meningococcal ACWY conjugate vaccine (MenACWY) (14 to 15 years): In 2021/22, Wandsworth’s rate was 78.9% (n=2069), which was the 10th highest in London, 0.8% lower than the England average and 4.8% higher than the London average. The latest Borough figure for 2021/22 was also 0.2% higher than in 2016/17, in comparison with 3.5% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

5.3 Immunisation Rates of Looked After Children

Children in care immunisations: In 2023, Wandsworth’s rate was 62.0% (n=106), which was the 5th lowest in London, 24.4% lower than the England average and 16.6% lower than the London average. The latest Borough figure for 2023 was also 28.1% lower than in 2012, in comparison with 1.3% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

6. 0–19 Years Services (School Nursing and Health Visiting)

A range of services exist for children and young people that promote and encourage positive health and well-being. Many are referenced in other parts of this JSNA, but for a population prevention programme section a key health related service is the 0–19 years Health Visiting and School Nursing Services.

6.1 School Nursing Service

The overarching aim of the school nursing element of the 0–19 years’ service is to develop and improve the emotional, physical, and mental well-being of children and young people. The service includes the following key components:

  • universal and specialist Public Health Services for children that promote the health and well-being of all children and reduce inequalities through targeted intervention for vulnerable and disadvantaged children aged 5-19 years, and their families
  • delivery of the Healthy Child Programme using holistic health assessment skills to establish where early intervention and preventive public health skills should be deployed
  • an important conduit between education and health services to ensure that children and their parents access appropriate medical and health support to enable children and young people to maximise their educational opportunities
  • maintain and develop a diverse set of clinical skills and/or specialities within the provider’s School Nursing Team to ensure the service can address a wide range of health needs, including the mental health and well-being needs of children and young people.

More specifically the School Nursing Service focuses on:

  • assessment and identification of the health and well-being needs of children and young people
  • offering advice, support and care that meets the needs of children and young people with the involvement of their parents and carers
  • building emotional well-being, resilience, and identifying mental health concerns at an early stage
  • preventing risky behaviours including smoking, alcohol, and drug misuse
  • providing sexual health and relationship education
  • delivering the National Child Measurement Programme in Reception and Year 6 in accordance with statutory requirements within the Health and Social Care Act 2012
  • reducing childhood obesity
  • meeting additional and complex needs with respect to mental health and disabilities, including vulnerable groups (children with Education and Healthcare Plans/SEND, Children with Child Protection Plans, Looked After Children, Children in Youth Offending Teams, Young Carers and Children in Need).

Prior to the pandemic, work had commenced to ensure the outcomes for the school nursing services were captured within key performance data to provide enhanced monitoring of the service. This work was put on hold during the pandemic following the NHS COVID-19 directives to re-focus NHS services to provide much needed increased capacity for the NHS emergency response. Some school nursing teams were re-deployed on an interim basis. Our local provider, however, retained a key focus on safeguarding while schools were closed. In March 2021 the government re-launched the Healthy Child Programme replacing the “4,5,6 model”, to focus on personalised assessments of needs and interventions to better respond to children and families’ needs across time.

The new model aims to capture the full extent of both the health visitor and school nurse offers, in recognition that local services’ provision goes beyond the five mandated contacts. The language of the “4,5,6 model” has now been removed and revised with increased opportunities for further contacts to provide additional support, especially during the early years. The model includes two additional universal contacts at 3-4 months and 6 months. This will provide important opportunities to address key public health priorities including perinatal mental health, child development, breastfeeding, childhood obesity prevention, immunisation uptake, and safe sleep.

Commissioners and public health are currently working with the provider to ensure the service meets both universal and targeted needs of children, young people, and families within the context of the ‘new normal’ alongside re-starting contract variation and Key Performance Indicators (KPI) discussions whilst embedding changes to the Healthy Child Model.

6.2 Health Visiting

The 0–19 years Health Visiting Service is commissioned to undertake interventions which result in the overall improvement of child health across Wandsworth and as such contribute to the achievement of the Child Health Measures as set out by the Department of Health and presented in table below 24.

National Measures of Child Health
National Measures of Child Health

This is achieved through adherence to all components of Department of Health’s 2009 Healthy Child Programme (HCP) 25 where a core universal service offer is balanced with effective and targeted responses to varying family needs, and accounts for the specific requirements of those with greater needs.

The HCP provides an evidence-based framework that identifies the necessary screening tests, immunisations, developmental reviews, information, and guidance necessary to support parenting and healthy choices to enable children to secure optimum health and well-being. Evidence shows that the HCP yields a good return on investment and that interventions are highly effective in securing healthy child development, positive future health and educational outcomes. This can reduce costs associated with dealing with problems such as mental ill-health and delayed learning, as well as child protection issues .

The 0–19 year service is currently commissioned to CLCH with the following objectives and service model:

  • improve the health and well-being of babies and children under five years and reduce inequalities in outcomes as part of an integrated multi-agency approach to supporting and empowering children and families
  • ensure a strong focus on prevention, health promotion, early identification of needs and early intervention with clear, effective plans
  • ensure the delivery of the Healthy Child Programme (HCP) to all children and families, including at each of the five mandated contacts
  • consider all adults with legal parental responsibility for the child as equal parents and fully include wherever this is practical and possible when working with families.

The revised service model, presented below, is based on the 4-5-6 Model, DoH, 2015

Healthy Child Programme
Healthy Child Programme

Source: OHID, Overview of the 6 early years and school aged years high impact areas (redesigned internally)

Additionally, in Wandsworth, CLCH is also commissioned to deliver the Family Nurse Partnership (FNP) which works with parents aged 24 years and under, partnering them with a specially trained family nurse who visits them regularly, from early pregnancy until their child is 2 years old. There are five contact points for the service: an antenatal contact, a home visit at 10–14 days, a home visit at 6–8 weeks, a home visit at 1 year (between 9–12 months) and a contact at 2- 2.5 years 26.

Child development: percentage of children achieving a good level of development at 2 to 2 and a half years: In 2022/23, Wandsworth’s rate was 69.7% (n=971), which was the 16th highest in London, 12.1% lower than the England average and 0.3% higher than the London average. The latest Borough figure for 2022/23 was also 20.3% lower than in 2019/20, in comparison with 4.8% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

The latest available published data reveals that in quarter 2 2019/20, 139 women in Wandsworth received a face-to-face antenatal visit from a health visitor. Families receiving a Health Visiting Service the following was achieved:

  • 93% of all new births received a new birth visit within 14 days (of 1033 new births in the quarter)
  • 90% of infants received a 6–8 week home visits by the time they were 8 weeks old (of 1039 infants in the quarter)
  • 72% of children received a 12-month review by the time they turned 12 months (of 1138 infants turning one in the quarter) and 92% had received the review by the time they reached 15 months
  • 70% of 2 to 2½ year olds received a 2 to 2½ year review in the quarter (of 1032 infants), 100% of which used the Age and Stages Questionnaire (ASQ).

6.3 Healthy Early Years Award Case Study

Healthy Early Years London (HEYL) is an awards scheme funded by the Mayor of London for all early year’s settings and childminders. It supports and recognises achievements in child health, well-being, and development. The HEYL Award builds on the success of Healthy Schools London and compliments the statutory Early Years Foundation Stage Framework, adding to the focus on children, families and staff, health, and well-being. The award is focused on a whole setting approach by involving children, parents, and the local community to create a healthy learning environment across 12 themes including:

  1. Healthy eating

  2. Breastfeeding and starting solid foods

  3. Oral health

  4. Physical activity

  5. Physical development

  6. Reducing sedentary behaviour

  7. Speech, language and communication

  8. Early cognitive development

  9. Social and emotional well-being

  10. Parenting and home learning

  11. Home safety

  12. Accident prevention and reducing injuries.

It is recognised by Ofsted as it is based on three Ofsted judgments and supports the Mayor of London’s upcoming ‘Better Health for Londoners Health Inequalities Strategy’. It aims to tackle health inequalities across the capital at the earliest opportunity in a child’s life.

The HEYL recognises that getting a good start in life, building emotional resilience, and getting maximum benefit from education are the most important markers for good health and well-being throughout life. Early Years settings can lay the foundations for lifelong health and well-being as they help children prepare for school.

There are 4 levels of the HEYL award: First Steps, Bronze, Silver and Gold. Each step with clear standards and criteria. Since the launch of HEYL in October 2018, 32 London boroughs have become involved in HEYL, and over 1,568 settings have registered to take part. The aim is to increase the number of early years settings taking part in the award locally which will positively have an impact on the health and well-being of children under 5 years by:

  • reinforcing healthy habits such as healthy eating, oral health, and daily physical activity
  • improving social and emotional well-being by increasing the early years and childcare uptake of the HEYL Project.

Early years settings are best placed and vital in laying the foundations for a long life, health and well-being, and enabling children to become ready for school.

As stated in the 2019 HEYL evaluation report, a considerable number of children’s services are spending time in childcare services with 13,262 registered early years providers offering 295,146 places. This shows that implementing the HEYL award programme has the potential to have an impact on the health of children across London. In Wandsworth, 53 early years settings have registered with the scheme and 37 have taken the first steps toward registration.

7. School Readiness

Children are assessed towards the end of reception year, data from which informs the education of individual children, and the planning of services which brings benefits to larger groups in the community.

7.1 Children Achieving a Good Level of Development

School readiness indicators in Wandsworth are consistently above both London and England percentages.

School readiness: percentage of children achieving a good level of development at the end of Reception: In 2022/23, Wandsworth’s rate was 71.9% (n=1877), which was the 6th highest in London, 6.9% higher than the England average and 4.0% higher than the London average. The latest Borough figure for 2022/23 was also 0.1% higher than in 2021/22, in comparison with 3.1% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

There is local recognition in Wandsworth that scores are beginning to plateau. Speech and language therapy (SALT) is embedded as part of the Children’s Centre’s offer, utilising group therapy and onward pathway to tier 3 specialist provision. The Children’s Team have a school readiness programme focusing on language enrichment and the identification of speech and communication difficulties. Health visitors have completed specialist speech and language training as part of a London wide initiative. The borough is working towards implementing the new Early Years Foundation Stage reforms which became statutory in September 2021 and has more of a focus on SALT for Early Years providers. Two key aims of these reforms are:

  • to place greater focus on language and communication
  • to support disadvantaged children and vulnerable groups.

Plans are to provide briefings for early years and childcare settings, headteachers and teachers, and continue to have training and professional development.

Throughout the pandemic Health Visiting Services have been key to ensuring all children reach a good level of development. Health visitors use the Ages and Stages Questionnaires and one year checks to assess if children’s social-emotional development is on schedule and identify those most likely to fall behind. Health Visiting Services were reduced during the pandemic following NHS National Directives. The service was temporarily re-fined to focus attention on those with higher needs, with the temporary suspension of some universal services. In response to the return to business as usual, the updated Healthy Child Programme combined with a significant national shortage of health visitors, commissioners and public health teams are re-structuring their services across London. This review programme, titled Reimagining Health Visiting, has been developed through consultation with staff, clients and commissioners, benchmarking with other 0-19 year services. This includes the review of commonalities across existing service specifications and demand, and capacity case modelling. It is also informed by the NHS Long Term Plan for England, CQC inspection feedback, review of caseload sizes, and different ways of working as a response to COVID-19.

As has been found nationally, the current clinical model for health visiting has been inflexible and the data set does not reflect the totality of what is delivered across the service. The new programme aims to rectify this. The Re-imagining Programme essentially seeks to move towards the use an ‘active’ and ‘community’ caseload model. The plan is to increase capacity for those identified as the most at need or at risk. Health visitors will be supported by an increase in the recruitment and deployment of staff nurses to support families assessed as requiring universal services. The initial antenatal and new birth visits will continue to be carried out by health visitors as will support for vulnerable families assessed as requiring a universal plus or plus services.

Healthy Early Years London in Wandsworth has been temporarily suspended due the ending of early years funding. Public health, in partnership with Wandsworth Early Years and Wandsworth Teaching Association, are developing a costed feasibility study to agree a way forward for the programme in Wandsworth.

Good Level of Development for Children on Free School Meals (FSM)

Despite Wandsworth’s high ranking for the overall school readiness for the reception year, the borough’s rank for the same indicator for children on FSM is much lower.

School Readiness: percentage of children with free school meal status achieving a good level of development at the end of Reception: In 2022/23, Wandsworth’s rate was 57.7% (n=301), which was the 13th highest in London, 11.9% higher than the England average and 0.2% lower than the London average. The latest Borough figure for 2022/23 was also 1.0% higher than in 2021/22, in comparison with 5.0% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

7.2 Communication and Language Development

Children who do not develop good oral language in early life are at greater risk of experiencing problems with literacy later, potentially impairing their ability to reach their academic potential. As the National Institute for Health and Care Excellence (NICE) explains: “Children and young people with communication difficulties are at increased risk of social, emotional and behavioural difficulties and mental health problems. So, identifying their speech and language needs early is crucial for their health and well-being. Many young children whose needs are identified early do catch up with their peers” 27.

Early identification and intervention ensure children start school in a position to flourish and minimises the development of gaps which can have a lasting detrimental impact. Research has shown that “children who had poor language skills at age five were about six times less likely to reach the expected standard in English and about 11 times less likely to reach the expected standard in maths at age 11” 28. In addition, only 15% of pupils with identified speech, language and communication needs achieve the expected standard reading, writing and maths at the end of primary school, compared with 61% of all pupils. As the government’s national plan to improve social mobility through education states: “Children who arrive at school in a strong position will find it easier to learn, while those already behind will face a growing challenge: early advantage accumulates, but so too does early disadvantage” 29.

Since 2011/12 there has been a steady increase in:

  • the percentage of children achieving the expected level in the Phonics Screening Check in Year 1, an increase of 20% to 85.5% by 2018/19
  • the percentage of children achieving at least the expected level in communication and language skills at the end of reception; more details below.

School readiness: percentage of children achieving at least the expected level of development in communication, language and literacy skills at the end of Reception: In 2022/23, Wandsworth’s rate was 74.0% (n=1932), which was the 5th highest in London, 7.5% higher than the England average and 5.1% higher than the London average. The latest Borough figure for 2022/23 was also 0.3% lower than in 2021/22, in comparison with 2.6% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

8. Hospital Admissions

8.1 Injuries and Accidents

Unintentional injuries form a major burden of disease in children and young people, and a major cause of inequality. In 2014/15, there were 19.6 million Accident and Emergency (A&E) attendances recorded at major A&E departments, single specialty A&E departments, walk-in centres and minor injury units in England. More than a quarter (25.9%) of attendances were made by children and young people (0–19 years). A&E admissions in Wandsworth have seen an encouraging downward trend in 0–19-year olds, statistically similar to the England average. However, trends in 0–4 years olds while significantly better than England, have seen an increasing trend in recent years. Attendances for this age group are often preventable, and commonly caused by accidental injury or minor illnesses which could be treated in primary care.

Under 5 Year Olds

Hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 4 years): In 2022/23, Wandsworth’s rate was 68.6 per 10,000 (n=125), which was the 11th lowest in London, 25.4% lower than the England average and 8.1% lower than the London average. The latest Borough figure for 2022/23 was also 35.9% lower than in 2010/11, in comparison with 35.9% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

0–14 Year Olds

Hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years): In 2022/23, Wandsworth’s rate was 58.7 per 10,000 (n=295), which was the 15th lowest in London, 22.0% lower than the England average and 2.3% lower than the London average. The latest Borough figure for 2022/23 was also 41.5% lower than in 2010/11, in comparison with 34.6% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

15–24 Year Olds

Hospital admissions caused by unintentional and deliberate injuries in young people (aged 15 to 24 years): In 2022/23, Wandsworth’s rate was 64.8 per 10,000 (n=240), which was the 13th lowest in London, 31.2% lower than the England average and 4.9% lower than the London average. The latest Borough figure for 2022/23 was also 44.4% lower than in 2010/11, in comparison with 39.2% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

8.2 Common Conditions

Lower Respiratory Admissions in Pre-school Children

Most of the lower respiratory tract infections in young children can be managed outside of hospital through better diet, hygiene and primary care support in advising and managing infections at home. High rates of hospitalisation might indicate the system for supporting predominantly young parents with managing their child’s lower respiratory infections has been inefficient.

Admissions for lower respiratory tract infections (2 to 4 years): In 2022/23, Wandsworth’s rate was 62.5 per 10,000 (n=65), which was the 8th highest in London, 45.8% higher than the England average and 35.8% higher than the London average. The latest Borough figure for 2022/23 was also 85.5% higher than in 2011/12, in comparison with 67.9% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Asthma Admissions

Admissions for asthma (0 to 9 years): In 2022/23, Wandsworth’s rate was 144.3 per 100,000 (n=50), which was the 15th lowest in London, 6.7% lower than the England average and 10.9% lower than the London average. The latest Borough figure for 2022/23 was also 37.2% lower than in 2010/11, in comparison with 50.4% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Epilepsy Admissions

Admissions for epilepsy (0 to 9 years): In 2022/23, Wandsworth’s rate was 28.9 per 100,000 (n=10), which was the lowest in London, 69.0% lower than the England average and 63.9% lower than the London average. The latest Borough figure for 2022/23 was also 31.3% lower than in 2010/11, in comparison with 3.5% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Diabetes Admissions

In 2018/19 in Wandsworth there were virtually no admissions for diabetes in children under 10 years old. PHE has suppressed the borough’s numbers and the rates have not been calculated for Wandsworth. However, diabetes admissions data is available for all under 19 year olds, including young people aged 10-18 years.

Admissions for diabetes (under 19 years): In 2022/23, Wandsworth’s rate was 40.7 per 100,000 (n=25), which was the 14th lowest in London, 22.4% lower than the England average and 8.1% lower than the London average. The latest Borough figure for 2022/23 was also 23.0% higher than in 2010/11, in comparison with 18.2% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

9. Healthy Weight in Children

The Government’s action plan to counteract the rise in childhood obesity 30 includes improving the nutritional content of food and drink, strengthening the information available to parents and the general public, and changing the way unhealthy food and sugary drinks are promoted. For example, removing offers for ‘buy one get one free’ on foods high in sugar. These actions are important to reduce the increasing financial burden the obesity epidemic is having on the NHS. Obesity-related health conditions are estimated to cost the NHS £6.1 billion per year 31.

9.1 Obesity and Overweight

Childhood obesity is defined as abnormal or excessive fat accumulation that presents a risk to health and is one of the most serious public health challenges of the 21st century 32. However, obesity is a complex issue and there is no singular solution. The UK is now ranked among the worst in Western Europe for childhood obesity rates and is one of the biggest health problems the country faces. Nationally, two thirds of adults, a third of 11–15 year olds, and a quarter of 2–10 year olds are overweight or obese.

Obesity and overweight disproportionately affects those from more deprived areas. This is seen most strongly in children with obesity prevalence, in the most deprived decile twice as high as those in the least deprived decile. Prevalence of obesity is also higher amongst children from particular ethnic minorities – boys in Year 6 from all Black Asian and Minority Ethnic groups are more likely to be obese than White British boys, and girls in Year 6 are more likely to be obese if they are from Black or Black African ethnic groups. Children with learning disabilities are also more likely to be overweight or obese.

In childhood, obesity is associated with several health risks, such as the development of eating disorders, musculoskeletal problems, respiratory problems and type 2 diabetes, which until recently was considered a health issue that only effected adults. Excess weight also has a significant impact on psychological well-being, with many children developing negative self-image and low self-esteem issues.

Obesity is most likely to be a result of diet and eating patterns and research indicates that 40% to 60% of obese school-age children become obese adults 33 and dietary behaviours established in childhood have been found to continue into adolescence and adulthood 34.

Obesity

Obesity in Reception

More than 1 in 5 children in England are obese or overweight by the time they start primary school, and this rises to one third by the time they are aged 11 years 35. In England, the National Child Measurement Programme (NCMP) measures the weight and height of children in primary schools in Reception (aged 4-5 years) and Year 6 (aged 10-11 years). The figures are based on large numbers of measurements and provide a robust assessment of obesity in children. However, the NCMP does not include children educated in the independent sector so the overall figures are incomplete.

Reception prevalence of obesity (including severe obesity): In 2022/23, Wandsworth’s rate was 7.9% (n=170), which was the 8th lowest in London, 14.2% lower than the England average and 15.7% lower than the London average. The latest Borough figure for 2022/23 was also 20.6% lower than in 2007/08, in comparison with 5.0% decrease in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Obesity in Year 6

By the time a child reaches Year 6 the percentage of obese children has increased three-fold.

Year 6 prevalence of overweight (including obesity): In 2022/23, Wandsworth’s rate was 34.8% (n=765), which was the 7th lowest in London, 4.9% lower than the England average and 10.4% lower than the London average. The latest Borough figure for 2022/23 was also 5.7% lower than in 2007/08, in comparison with 12.2% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Obesity prevalence by ethnic group

Childhood obesity prevalence changes with age and ethnic group. In Wandsworth and nationally, the prevalence of obesity is the highest in Black ethnic groups and the lowest in White ethnic groups; the prevalence in Asian ethnic groups was somewhere in the middle. Interestingly, the pace of increase in obesity prevalence between reception and Year 6 varies even more substantially. For Black ethnic groups, the prevalence in Year 6 is 181% higher than in reception, in comparison with a 261% increase in white ethnic group and 316% increase in Asian ethnic groups, as per charts below.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Overweight

Overweight in Reception

Reception prevalence of overweight (including obesity): In 2022/23, Wandsworth’s rate was 19.2% (n=415), which was the 15th lowest in London, 10.0% lower than the England average and 4.3% lower than the London average. The latest Borough figure for 2022/23 was also 10.5% lower than in 2007/08, in comparison with 5.7% decrease in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Overweight in Year 6

Year 6 prevalence of overweight (including obesity): In 2022/23, Wandsworth’s rate was 34.8% (n=765), which was the 7th lowest in London, 4.9% lower than the England average and 10.4% lower than the London average. The latest Borough figure for 2022/23 was also 5.7% lower than in 2007/08, in comparison with 12.2% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

9.2 Healthy Weight in Children

Healthy Weight in Reception

Reception prevalence of healthy weight: In 2022/23, Wandsworth’s rate was 79.7% (n=1725), which was the 10th highest in London, 2.8% higher than the England average and 2.0% higher than the London average. The latest Borough figure for 2022/23 was also 3.2% higher than in 2007/08, in comparison with 1.8% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Healthy Weight in Year 6

Year 6 prevalence of healthy weight: In 2022/23, Wandsworth’s rate was 63.6% (n=1400), which was the 7th highest in London, 2.9% higher than the England average and 7.6% higher than the London average. The latest Borough figure for 2022/23 was also 4.7% higher than in 2007/08, in comparison with 6.3% decrease in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

9.3 Underweight Children

A child is classed as underweight when their body mass index (BMI) is less than the 2nd centile of the UK90 growth reference 36.

Underweight in Reception

Reception prevalence of underweight: In 2022/23, Wandsworth’s rate was 1.2% (n=25), which was the 9th lowest in London, 0.1% lower than the England average and 36.5% lower than the London average. The latest Borough figure for 2022/23 was also 15.9% lower than in 2007/08, in comparison with 7.6% decrease in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Underweight in Year 6

Year 6 prevalence of underweight: In 2022/23, Wandsworth’s rate was 1.6% (n=35), which was the 10th lowest in London, 1.8% higher than the England average and 21.7% lower than the London average. The latest Borough figure for 2022/23 was also 31.6% lower than in 2007/08, in comparison with 10.9% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Eating disorders

The data in table below has been obtained from the North East London Commissioning Support Unit. It shows the number of child eating (ED) disorder contacts at CAMHS for the months of April to July 2021/22.

Source: NEL Commissioning Support Unit

We do not have available data to fully explore the impact of eating disorders on Wandsworth’s children and young people. The following data is taken from the most recent national study carried out by NHS Digital.

The 2017 Mental Health in Children and Young People Survey identified that 0.4% of 5-19 year olds surveyed had an eating disorder. Eating disorders were more common in girls (0.7%) than boys (0.1%), and in older age groups (0.1% of 5-10 year olds; 0.6% of 11-16 year olds; 0.8% of 17-19 year olds). Rates of eating disorder were higher in girls aged 17 -19 years (1.6%) than in other demographic groups. While the pattern of association between presence of eating disorder and age group looks different between girls and boys, this was not statistically significant.

The survey confirms an expected profile for eating disorders. While it can affect boys, it is primarily a disorder experienced by girls. The findings confirm the established pattern that vulnerability to eating disorder increases with age. The survey found a prevalence of one in sixty girls aged 17-19 years in every two classes. Girls aged 11-16 years eating disorders were evident in one in a hundred. These figures should be considered as possible underestimates.

The Wandsworth Public Health Department is conducting a comprehensive Mental Health Needs Assessment (MHNA) 2021/2022. This needs assessment will incorporate an in-depth review of the latest data available to identify the estimated prevalence of mental disorder in Wandsworth and will include eating disorders. The MHNA will use the NHS Digital national study Mental Health in Children and Young People 2017 (MHCYP, 2017) to estimate the number of girls and boys that we would expect to have an eating disorder. The MHNA will also examine service demand and utilisation for a more complete picture of need.

9.4 Prevention of Childhood Obesity

The causes of obesity and being overweight are multi-factorial, no one single factor can be attributed. The obesity systems map outlines the main areas that contain variables which are considered to affect the outcome of obesity directly or indirectly including environmental, societal and individual themes 37. These include variables such as an individual’s psychology and physiology, and the food and activity environment.

A growing body of evidence suggests a whole systems approach could help tackle obesity. The recent Public Health England document ‘Whole Systems Approach to obesity: A Guide to Support Local Approaches to Promoting a Healthy Weight’ is a professional resource designed to support local action. The guide describes a process, which can enable local authorities and their partners, to create a local whole systems approach to reducing obesity and promoting a healthy weight. It is understood there is no one singular solution; causes of obesity exist in the places where we live, work and play. The guide does not specify which policies, interventions or actions local areas should include in a whole systems approach. The approach needs to be agreed collectively by local stakeholders to reflect the local context 38. In 2019 the London Child Obesity Taskforce launched ‘Every Child a Healthy Weight’ campaign, which outlines ten ambitions on areas that are understood to reduce the risk of lifelong ill health for children. These ambitions have been chosen to reflect the circumstances in which children may live that makes it difficult for them to eat healthy food, drink water and be physically active.

Healthy Eating

At its simplest, excess weight in children is caused by an energy (calorie) imbalance and consuming too much energy compared with an expenditure. Children in the UK have diets that are too high in energy-dense foods, saturated fat and free sugars (sugars that are added to our food), all of which contribute to this imbalance. Children also consume too little fibre, fruit and vegetables 39 which counteract the overconsumption of calorie-dense foods by filling us up more than processed, sugary foods.

The adoption of a healthy diet from as young an age as possible is recommended 40. In general, a healthy diet is rich in fruit and vegetables, wholegrains, legumes and nuts, and low in foods high in saturated fat, salt and sugar. It is recommended that at least 400 grams (equivalent to approximately five portions of 80 grams) of fruit and vegetables per day (excluding starchy root vegetables) are consumed from two years of age 41.

The Public Health England Eatwell Guide 42 and the Department of Health ‘5 A Day’ Campaign aim to improve diet and nutrition in the general population and have been promoted widely. Nevertheless, only 18% of 5-15 year olds eat the recommended ‘5 A Day’ 43.

Research has indicated that over the last 20 years there has been a dramatic reduction intake in key nutrients in children, such as vitamin A, folate, calcium, zinc, iron and iodine 44, all of which are available in a healthy, nutrient-rich diet 45.

The implications of this are children from a young age do not have the required nutrients to support growth and development including the formation of healthy teeth, bones, body tissues and normal nerve function 46.

Breastfeeding

Risk factors begin from birth, starting with an increased risk of obesity for children who are not breastfed 47:

  • the number of children being breastfed in Wandsworth continues to increase
  • Wandsworth has seen an overall improvement in 6–8 weeks breastfeeding prevalence rates between 2018 to 2019, from 26% in Q1 to 79% in Q4
  • the overall total for the year is 56% which is higher than the England average of 42.7% 48.

Physical Activity

To stay healthy or to improve health, young people aged 5–18 years need to do three types of physical activity each week; aerobic exercise, exercises to strengthen bones, and exercises to strengthen muscles 49. Data on physical activity in children and young people in Wandsworth is scarce. The latest available borough’s data comes from Active Lives Children and Young People Survey, Sport England for year 2020/21.

Percentage of physically active children and young people: In 2022/23, Wandsworth’s rate was 58.8%, which was the highest in London, 25.1% higher than the England average and 28.7% higher than the London average. The latest Borough figure for 2022/23 was also 34.8% higher than in 2017/18, in comparison with 8.7% increase in England’s rate in the equivalent time period. Missing time series data for Wandsworth have been estimated using linear interpolation.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

School nurses are in all schools across the borough and offer services to home educated children. School nurses conduct the NCMP and measure all children in Reception and Year 6. Children who are identified as overweight or obese are provided with appropriate support and advice and referred to the Health4Life Child Weight Management Service. This is run by CLCH and provides a family-based approach covering nutrition and physical activity.

The Family Weight Management Service is also available for children aged 2–5 years (pre-school) with weight more than 2 centiles above average height centile (using the UK-WHO 0–4 years growth charts in the red book), and women who have given birth in the previous two years who are obese (BMI ≥30). This is also run by CLCH as part of the 0–19 year old service. Wandsworth is also part of the Healthy Early Years London (HEYL) award scheme.

10. Oral and Dental Health

10.1 Decayed, Missing or Filled Teeth in 5 Year Olds

dmft (decayed, missing or filled teeth) in five year olds: In 2018/19, Wandsworth’s rate was 0.4 mean dmft per child, which was the 2nd lowest in London, 49.9% lower than the England average and 56.8% lower than the London average. The latest Borough figure for 2018/19 was also 52.3% lower than in 2014/15, in comparison with 5.2% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

10.2 Visually Obvious Dental Decay in 5 Year Olds

Percentage of 5 year olds with experience of visually obvious dental decay: In 2021/22, Wandsworth’s rate was 21.3%, which was the 10th lowest in London, 10.1% lower than the England average and 17.6% lower than the London average. The latest Borough figure for 2021/22 was also 29.0% lower than in 2007/08, in comparison with 23.4% decrease in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

11. Children and Young Peoples’ Mental Health

Mental health outcomes in young people aged 10–24 years are driven by economic disadvantage, and inequalities relating to other social determinants, such as ethnicity. The evidence from data on the causes of young people’s mental health across London include:

  • an increase in the number of young people over the age of 16 going into care
  • a significant rise in secondary school exclusions in England
  • high rates of loneliness and
  • despite falling unemployment rates young people are increasingly engaged in precarious employment such as zero-hour contracts.

Further detail on the mental health needs of children and young people can be found in Wandsworth Local Transformation Plan (LTP) for Children and Young People’s Mental Health and Emotional Well-being.

The percentage of school pupils with social, emotional and mental health needs in Wandsworth at 3.81% is significantly higher than both London and England levels (2.61% and 2.81% respectively) 50. This reflects wider social factors where pupils attend school and live in the borough.

The single largest reason that young people are referred into Wandsworth’s NHS Child and Adolescent Mental Health Service (CAMHS) Single Point of Access (SPA) is concerning behaviour. The reasons for behavioural problems can be because of parenting, environmental factors, and problems at school, such as bullying. However, behaviour problems can be because of a traumatic experience and because of social and communication difficulties, including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). For these reasons, there has been joint working between the Council and CCG to commission a range of targeted and specialist support services for these young people most of which are accessible pre-diagnosis. These services include teams of drama therapists working in schools, provision from Contact, a voluntary sector organisation, psychologists and systemic therapists that work within the new Wandsworth Autism Advisory Service, Pupil Referral Units and schools. Wandsworth is the only borough in South West London to have a dedicated and specialist CAMHS Service for children with learning disabilities. Wandsworth has also invested in new treatments including Dialectical Behavioural Therapy (DBT) and Positive Behavioural Support (PBS) to help child and young people with more severe levels of challenging behaviour.

The second and third largest reasons for referrals into the CAMHS single point of access are anxiety, low mood and depression. Our partnership has invested in a large scaling up of support services, including our new Mental Health in Schools Trailblazers and Mental Health Clusters. We have divided all schools within the borough into four areas: Battersea, Balham & Tooting, Putney & Roehampton and Southfields & Wandsworth Town. Each of these areas has a team of specialists who are providing evidence-based treatments for anxiety, low mood and depression. Each team of specialists include a clinical psychologist, four education well-being practitioners trained in delivering new treatment models, drama psychotherapists, and occupational therapists supporting those children who have experienced trauma or have special sensory needs.

A smaller number of referrals are also received by the single point of access because of self-harm, obsessive compulsive disorders, emotional dysregulation, concerning sexualised behaviours, eating disorders and bereavement.

11.1 Children with Significant Social, Emotional and Mental Health Needs

School aged children with Significant Social, Emotional and Mental Health Needs is an indicator from PHE Public Health Profiles. The data represents the number of school children with special education needs (SEN) who are identified as having social, emotional and mental health as the primary type of need, expressed as a percentage of all school pupils. The Mental Health in Children and Young People Survey 2017 identified an estimated 4,800 children and young people in Wandsworth aged 5-17 years with a mental disorder. This includes emotional, behavioural and hyperactivity disorders, those on the autism spectrum, and those with eating and other less common disorders.

Primary School Children

School pupils with social, emotional and mental health needs: % of school pupils with social, emotional and mental health needs: In 2022/23, Wandsworth’s rate was 3.6% (n=671), which was the 2nd highest in London, 28.6% higher than the England average and 50.0% higher than the London average. The latest Borough figure for 2022/23 was also 26.5% higher than in 2015/16, in comparison with 34.4% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles

Source: OHID: Public Health Profiles

Secondary School Children

School pupils with social, emotional and mental health needs: % of school pupils with social, emotional and mental health needs: In 2022/23, Wandsworth’s rate was 4.4% (n=582), which was the 4th highest in London, 25.7% higher than the England average and 37.5% higher than the London average. The latest Borough figure for 2022/23 was also 17.7% lower than in 2015/16, in comparison with 48.5% increase in England’s rate in the equivalent time period.

Source: OHID: Public Health Profiles