Connection with other policy areas and (How does it fit/support wider early years work and partnerships)

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1 Illness such as gastroenteritis and upper respiratory tract infections, along with injuries caused by accidents in the home, are the leading causes of attendances at Accident & Emergency and hospitalisation amongst the under 5s. Unintentional injuries are the major cause of morbidity and premature mortality for children and young people. There is a strong link between unintentional injury and inequality, with children from the most disadvantaged families far more likely to be killed or seriously injured. Death rates for injury and poisoning have fallen for all social groups except the poorest: these children are 13 times more likely to die. Removal of teeth is the highest cause of anaesthesia in under 5s. Early Years High Impact Area 5 Managing minor illness and reducing accidents (reducing hospital attendance/ admissions) (What and why including context) The average number of visits to the GP each year by pre-school children is 6; during school age this falls to 2 3. Around 1 in 11 children utilise hospital outpatients and 1 in are admitted overall. Around half of under 1 year olds visit an Accident & Emergency department, leading to 1 in 3 being admitted. Health visitors are a trusted source of knowledge, advice and information for parents and are often the first point of contact for parents who are unsure on the best course of action when their child is unwell. As such they play an important role in the primary care team and can help to reduce the burden on busy GP surgeries and A&E departments. This document was produced by the Department of Health in collaboration with the Local Government Association, Public Health England, NHS England, Health Education England and Early Intervention Foundation.

2 The health visitor will also lead and support delivery of preventative programmes for infants and children through the Healthy Child Programme including advice on oral health, accident prevention and links to safety schemes. Health visitors are able to provide help and support to new parents on a range of common minor childhood illness such as fever, cough and colds, vomiting and diarrhoea, building parental confidence and knowledge on self-management and when to seek help. They provide advice and guidance on the signs and symptoms and management of more serious diseases such as meningitis, bronchiolitis and chicken pox, both to families and in settings such as Children s Centres in the event of local disease outbreaks and often are prescribers and can support in management of diabetes, epilepsy, skin conditions and asthma, stabilising symptoms through the correct use of medication. They also provide brief interventions and referral to specialist services. Health visitors are in a strong position to raise parental awareness of the biggest risks and to provide clear, practical and accurate safety advice. As well as raising safety issues with parents at universal contacts, such as the child development checks, and during targeted followup after A&E attendances, health visitors can provide a highly effective drip-feed of safety advice to parents attending child health clinics, baby clubs and other activities. Health visitors work with Children s Centres to ensure that safety messages are promoted across early years settings and are consistent, tailored to the needs of the local population eg ethnic minority families, young parents etc. They have a primary and secondary prevention role. Promotion of breastfeeding, bottle hygiene awareness, immunisations, supporting parents to give up smoking and messages such as Choose Well, Smoke Free Environment can reduce attendances at A&E and subsequent hospital admissions. The focus being prevention rather than crisis, whilst at the same time being the eyes and ears of the service and identifying potential safeguarding issues. Health visitors also make links and work with the Local Authority and multi-agencies on wider determinants of health, such as housing, health and safety. Development of local pathways to provide care out of hospital or at home are effective in reducing hospital admissions. Health visitors have an important role to play in primary and secondary prevention as an integral part of these pathways.

3 Measures of Success/Outcome Measures (Including Public Health Outcomes Framework or future Child Health Outcomes Framework measure/placeholder, interim proxy measure, measure of access and family experience) Access: Coverage of universal elements of the Healthy Child Programme (all visits include accident prevention) via NHS England service delivery metrics. Effective delivery: Evidence of the following evidence based local pathways: infant feeding including breastfeeding support; conservative and preventative dental care for young children with dental pain; maternal mental health, and child and parent interaction via local commissioner and provider data. Outcomes: Health Episode Statistics data on non-elective admissions for 0-4s. Local data can be obtained setting out top ten primary diagnoses. Follow up of all A&E discharge information on attendances Parental experience: feedback from health visitor service user experience questioaire on satisfaction with delivery of the Healthy Child Programme via local commissioner and provider data. Could include immunisation uptake and percentage of women smoke free at time of delivery, breastfeeding prevalence at 6-8 weeks Coection with other policy areas and (How does it fit/support wider early years work and partnerships) The High Impact Area documents have been developed to support delivery of the Healthy Child Programme and 0-5 agenda, and also to highlight the link with a number of other intercoecting policy areas eg early intervention, health inequalities, troubled families, vulnerable children and social justice. The importance of effective outcomes relies on strong partnership working between all health partners (primary and secondary), Local Authority partners including early years partners, and third sector (voluntary) partners. Urgent care pathway Reducing health inequalities Safeguarding children Working together Safeguarding guidance Integrated working and service delivery Chief Medical Officer Report Primary care as essential partners Close interface with midwifery and school nursing services for effective transition and care plaing Special Educational Needs reforms Health and Social Care plans

4 How will we get there? System Levers Improvement Professional/Partnership Mobilisation Public Health Outcomes Framework indicator reported and benchmarked by Public Health England and NHS England NHS England Service Specification supports the high impact areas and delivery of the Healthy Child Programme Information sharing agreements in place across all agencies Integrated commissioning of services Improved accessibility for vulnerable groups Integrated IT systems and information sharing across agencies Development and use of integrated pathways including primary care and community services to avoid admissions Systematic collection of user experience eg Friends and Family Test to inform action Multi-agency training to identify common themes and advice on appropriate accident prevention Continued multi-agency safeguarding training Effective delivery of universal prevention and early intervention programmes Improved understanding of the Joint Strategic Needs Assessment and Health and Wellbeing Board information Partnership working with Children s Centres to support integrated plaing, delivery, monitoring and review Information sharing from Joint Strategic Needs Assessment (including Early Years Foundation Stage Profile data, health data and information about families and communities) to identify and respond to joint priorities Collation of local data by top ten primary diagnoses Commission partnership preventive support programmes to avoid hospital admissions based on local data Increased use of evidence-based and multi-agency interventions to improve parenting and attachment Improved partnership working eg maternity, school nursing and early years settings Consistent information eg on accident prevention for parents and carers Identification of repeat attendance for non-elective admissions Development of systems to capture interventions to reduce injuries Integrated working of health visiting services within existing Local Authority arrangements to improve services for children, parents and families through a holistic approach Identification of skills and competence to inform integrated working and skill mix Health visitors to be aware of how the Child Protection Information System works (due to go live 2015) in hospitals Understanding barriers to primary care access Primary care and community services to support out of hospital care

5 Associated Tools and Guidance (including pathways etc) Healthy Child Programme: Pregnancy and the first five years, Department of Health PH29 Strategies to prevent unintentional injuries among the under-15s NICE public health guidance guidance.nice.org.uk/ph29/quickrefguide/pdf/english PH30 Preventing unintentional injuries among the under-15s in the home NICE public health guidance publications.nice.org.uk/preventing-unintentional-injuries-among-the-under-15s-in-the-home-ph30 PH21 Reducing differences in the uptake in immunisation NICE public health guidance PH26 Quitting smoking in pregnancy and following childbirth NICE public health guidance nice.org.uk/quitting-smoking-in-pregnancy-and-following-childbirth-ph26 PH1 Brief interventions and referral for smoking cessation: NICE public health guidance Routine postnatal care of women and their babies NICE Guidance July pdf/cg37niceguideline.pdf Emotional Health and Wellbeing pathway https://www.gov.uk/government/uploads/system/uploads/attachment_data/ file/299268/emotional_health_and_wellbeing_pathway_interactive_final.pdf Safeguarding Pathway PROFESSIONAL-GUIDANCE.pdf Aual Report of the Chief Medical Officer Our Children Deserve Better: Prevention Pays. Department of Health, 2013 https://www.gov.uk/government/news/chief-medical-officer-prevention-pays-our-children-deserve-better Health Visiting and School Nursing Programme: Maximising the Support for 0-19, Children with Complex Disabilities and/or Additional Health Needs Department of Health, in draft Why Children Die Royal College of Paediatrics and Child Health, National Children s Bureau and British Association for Child and Adolescent Public Health May why_children_die part_a.pdf National Health Visitor Service Specification 2014/15, NHS England March Guide to the Early Years Profiles NHS England March uploads/2014/03/hv-ey-hlth-prof.pdf

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