Agenda item

Purpose: To review Early Years Health Inequalities in West Berkshire to gain an understanding of the current picture, gaps in provision and identify opportunities for improvement.

Gayan Perera (Public Health Intelligence Manager) presented the report on early years and school readiness in West Berkshire.

During the presentation the following points were highlighted:

• What happened from pre-conception to age five was fundamental for physical and emotional health all the way through to adulthood.
• National evidence was shared showing how investment in early years intervention saved money in the longer term. The cost vs benefit analysis of different interventions was highlighted. 
• Data showed that West Berkshire was doing well compared to Southeast England and National scales for low birth rate, smoking at time of delivery and babies first feed of breastmilk.
• However, it was noted there were hidden communities and inequalities. For example, 2000 children in West Berkshire were identified as children in need by Children’s Services.
• Some indicators had room for improvement such as the proportion of children receiving a 12-month review by health visiting services. It was noted that this was improving over time. Newborn hearing screening could also be improved. It was essential to focus on children in need or living in the most deprived areas.
• Immunisation data was shared which advised that rates were good in West Berkshire. However, they were striving for 100% to improve vaccination levels.
• It was highlighted that there were inequalities in school readiness. For primary school children eligible for free school meals, there was a higher rate with a primary need of emotional, social or mental health than those not eligible.
• Interventions were therefore essential for a small cohort of children. To address this, it was important to focus on families, children, communities and services. Data was shared with example indicators that could help to measure and identify areas for focus.
• The five key themes to improve school readiness were good maternal mental health, learning activities, physical activity, parenting support programmes and high-quality early education. Evidence-based interventions were essential.
• An Early Years Inequalities working group had been set up to look into the school readiness indicator that had been highlighted as a concern. This would bring together different partners to identify the reasons for this and to address it.
• It was noted that the number of children on free school meals (240) was small and that may contribute to the poor rating. It was also not the best way to identify disadvantaged children as a child could be eligible one year and not the next.

Avril Allenby (Service Manager for Early Years, Vulnerable Learners & Families) noted some of the work happening in West Berkshire and highlighted the following:

• Family Hubs worked with parents alongside health visiting and maternity services to identify the most disadvantaged children. They selected some groups of parents to work with closely on how to best support their child. There were also some universal offers at Family Hubs around reading and learning together.
• In West Berkshire there was an 82 – 85% uptake of vulnerable two-year old entitlement. The settings that provided this were worked with closely to ensure they were well equipped to support children with speech and language, and early reading. 
• There was a Every Child A Talker (ECAT) programme which focussed on developing the four areas necessary for children to be confident in their speech and language. There were very good practitioners in early years settings.
• There was targeted work with parents around early reading called Flying Start. This was a six- or seven-week programme. They worked alongside schools that had the highest number of free school meal entitlements to help parents to come along to sessions. This was very successful for the children reached, but they hoped to reach more children.
• There was an App called 50 things to do outside. It was a West Berkshire focussed way to get families out of the home and into the local environment and to get children to do physical activities.
• It was noted that the identification of vulnerable two years olds was slightly different to the free school meal entitlement criteria. When school readiness was compared educationally, they used the foundation stage profile which was a teacher assessment of children across a number of areas at the end of the reception age. It was difficult to influence as it sat within schools. In some schools there could be only one child whereas other schools had clusters of children. They tried to support those schools with clusters and so it was harder to support some smaller schools. This was the group causing the gap in school readiness.

Nerys Probert (Acting Senior Public Health Programme Officer) gave a brief overview of the report on the West Berkshire Health Visiting Service.

During the presentation the following points were highlighted:

• The Health Child Programme - Service Model was explained as per the report. This included the universal, targeted and specialist services, and the reviews and visits made with all children until aged two and a half years.
• An overview of the West Berkshire Health Visiting Delivery model was shared. Berkshire Healthcare NHS Foundation Trust (BHFT) was commissioned by the Council to deliver the service. There was a skill mix of health visitors, staff nurses and nursery nurses. There were home visits, well-baby clinics and infant feeding drop-ins that were often at family hubs. 
• As commissioners of the service, the Council received reports on safeguarding by the service provider.
• The purpose of the service was primary prevention.
• The indicators showed that West Berkshire was doing the same or better than national targets in most areas except for the 12-month review and the two-to-two-and-a-half-year review. The reviews were still undertaken, but were outside of the timeframe. This was due to catching up following covid and due to a shortage of health visitors nationally. The data in the report was from 2022-23. The Council had more up to date data for last year, it was back on target and all posts were currently filled.

Action: Nerys Probert to provide further detail on the digital offer for three and six-month contacts.

Sally Murray (Head of Children’s Commissioning, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB)) gave a brief overview of the report on Early Years Inequalities. The following points were highlighted:

• The multi-agency West Berkshire Early Years Inequalities Group would be a key piece of work over the next 12 months. There was a correlation between school readiness, and speech and language needs in early years.
• The ICB therapies review took place in 2023. The services would be recommissioned in 2024. The commissioning arrangements were included in the report.
• The demand for services has increased since the pandemic, however the trend had been increasing pre-pandemic. Of note there had been a 21% increase in speech and language therapy (SLT) demand in less than two years. This meant that the delivery model had shifted towards a more needs led, early advice, prevention and intervention model.
• There was now an advice line where parents could speak with a speech and language therapist two days a week. This had been very successful in avoiding people sitting on a waiting list. There were 177 people on the waiting list at the start of the year, but there was no one on the waiting list at the present time. If an assessment was needed that would be booked in, however strategies were shared in the call, there was an online offering and a referral to an early language development workshop. These were online monthly workshops designed to help parents and carers. There was also an in person workshop on the Health Bus. The workshops were very popular, and families reported a high level of satisfaction with them.
• BHFT also provided Early Years Surgeries for early years settings. They had a targeted training offer available later this year and provided an information pack with advice and strategies.
• The BHFT website provided detailed information and advice on communication and hearing.
• There was also a project called the Through My Eyes project which looked at social communication skills. 650 children were identified as at risk of speech, language and communication developmental delay. Early years settings and parents were enabled to support language development. The children were monitored, and outcomes would be reviewed. This was monitored through the ECAT programme.
• An overview of the Occupational Therapy and support for sensory processing difficulties was shared. There was training and advice for families and settings, Early Years sensory processing workshops, sensory processing videos on YouTube and an online toolkit.
• The Physiotherapy provision was shared. This was based at Royal Berkshire Hospital or by BHFT.
• Emotional health and wellbeing support of early years was for parents and families. The Health Visiting team and GPs offered support. There was also a Health Bus, online forums and the ICB also commissioned Autism Berkshire working with Parenting Special Children.
• It was also noted that in addition to GPs and Health Visitors for general health and development in Early Years, there were paediatricians at the Dingley Child Development Centre who brought together specialists for children who needed help to overcome a developmental issue or a complex illness.

During the Committee’s discussion the following points were raised:

• It was noted that the previous model of a referral, waiting list and assessment meant a delay in receiving advice and support. The new model provided advice and support much earlier which had a speedier impact. The advice and support was in the family setting and in the early years setting. Strategies were shared early on. If it sounded like the child needed an assessment they would be added to a list with a shorter wait. It was noted that some people were hard to reach and that was why the family hubs were critical.
• Concern was raised that there was not enough provision for parents to access support. For example, the central family hub was in Thatcham, other provisions in Newbury were either run by volunteers at Educafe or other settings where some payment may be needed. It was agreed that from a primary prevention view, more services such as drop-ins for parents were needed. However, the current health visiting service provided was the best that could be provided with the resources available. There were also limitations in the spaces available.
• Provision in rural areas was also highlighted as the three family hubs were particularly difficult for people living in villages. It was confirmed that in addition to the three family hubs, there were activities at other locations such as sessions at village halls depending on need.
• It was noted that the cost-benefit evidence was overwhelming, but there remained a concern that resources were stretched and parts of West Berkshire were lacking provision. It was agreed that there was a limited budget, but they were using the evidence to inform the range of services provided.
• It was noted that it was essential to target the cohort that were most in need. A question was raised around the use of the free school meal applications as a way to identify those children as not all families claimed the entitlement. This meant that practitioners needed to know the local families effectively. It was also important to ensure data was easily shared between the Council and Health services. It was clarified that Public Health were working with other organisations to improve the model and ensure that data was shared.  This would also be part of the work of the Early Years Health Inequalities Group. 

Action: An update from the Early Years Health Inequalities Group to be added to the work programme.

RESOLVED to note the report.