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 . 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 .
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) .
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).
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)
. 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 .
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
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 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 . 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 . 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 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 . 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 .
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 .
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 .
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 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 CLCH 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% .
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
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 .
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
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 .
National Measures of Child Health
This is achieved through adherence to all components of Department of
Health’s 2009 Healthy Child Programme (HCP) 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
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 .
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:
Healthy eating
Breastfeeding and starting solid foods
Oral health
Physical activity
Physical development
Reducing sedentary behaviour
Speech, language and communication
Early cognitive development
Social and emotional well-being
Parenting and home learning
Home safety
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” .
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” . 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” .
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
9. Healthy Weight in Children
The Government’s action plan to counteract the rise in childhood
obesity 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 .
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 . 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 and dietary behaviours established in
childhood have been found to continue into adolescence and adulthood .
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 . 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 .
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 . 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 . 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 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 . 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 .
The Public Health England Eatwell Guide 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’ .
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 , all of which are
available in a healthy, nutrient-rich diet .
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 .
Breastfeeding
Risk factors begin from birth, starting with an increased risk of
obesity for children who are not breastfed :
- 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% .
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 . 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.
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) . 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