Children s Trust Board Sponsors: Derek Higton and Kate Allen TEENAGE PREGNANCY INTEGRATED COMMISSIONING STRATEGY UPDATE

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1 Report to Children s Trust Board 6 th June 2013 Agenda Item 2 Children s Trust Board Sponsors: Derek Higton and Kate Allen TEENAGE PREGNANCY INTEGRATED COMMISSIONING STRATEGY UPDATE Purpose of the Report 1. To brief members on the annual progress of the implementation of Nottinghamshire s Teenage Pregnancy Integrated Commissioning Strategy. 2. To inform the Children s Trust Board of the progress in relation to reducing teenage conceptions using the National Office of Statistics latest data for 2011 teenage conception rates. 3. To gain advice from the Children s Trust Board on how we engage Clinical Commissioning Groups in the work to tackle teenage pregnancy. 4. To seek ratification from the Children s Trust Board for the refreshed Teenage Pregnancy Strategy. Information and Advice Why is Tackling Teenage Pregnancy Important? 5. Teenage pregnancy can be both a cause and a consequence of social exclusion and is more common in areas of deprivation. The poorer outcomes associated with teenage motherhood also mean the effects of deprivation and social exclusion are passed from one generation to the next. 6. Evidence clearly shows that having children at a young age can damage young women s health and emotional well-being, and severely limit their education and career prospects, resulting in increased levels of poverty and social exclusion. Research shows that children born to teenagers are more likely to experience a range of negative outcomes in later life, and are up to three times more likely to become a teenage parent themselves. Most young parents do not regret having their children but wish they had waited until they were older. These findings are reflected also in Nottinghamshire. 1

2 Figure 1: The Impact of Teenage Pregnancy on Children and Families Poverty Education and Aspiration Poor Health Impact on the Economy We know that at age 30, teenage mothers are 22% more likely to be living in poverty than mothers giving birth aged 24 or over, and are much less likely to be employed or living with a partner. Research also informs us that children of teenage mothers have a 63% increased risk of being born into poverty compared to babies born to mothers in their twenties and are more likely to have accidents and behavioural problems. Rates of teenage pregnancy are higher among communities affected by deprivation and poverty and are higher where educational attainment is lower. The poorer outcomes associated with teenage motherhood also mean the effects of deprivation and social exclusion are passed from one generation to the next. Teenage mothers and their children are less likely to do as well as their peers. Teenage mothers are 20% more likely to have no qualifications at age 30 than mothers giving birth at 24 years or over. 70% of teenage mothers are not in education, training or employment. The infant mortality rate for babies born to teenage mothers is 60% higher than for babies born to older mothers aged Children of teenage mothers are at increased risk of lower educational attainment and have lower economic activity in adult life. Teenage mothers are three times more likely to get post-natal depression than older mothers; they are at a higher risk of poor mental health for three years after the birth, three times more likely to smoke during pregnancy than mothers over 30; and one third less likely to breastfeed. All of which have a negative impact on the child. Teenage mothers, young fathers and their children are more likely to be in poor health and to live in poor housing The cost of teenage pregnancy to the NHS alone is estimated to be 69m a year. Teenage mothers will also be more likely than older mothers to require expensive support from a range of local services. 7. The challenge for Nottinghamshire, therefore, is to provide young people with the means to avoid early pregnancy, but also to tackle the underlying circumstances that motivate young people to want to, or lead them passively to become pregnant or young parents at a young age. Teenage Pregnancy Governance 8. The Teenage Pregnancy Integrated Commissioning Group is a sub group of the Children s Trust which in turn reports to the Health and Wellbeing Board. 9. The Teenage Pregnancy Integrated Commissioning Group includes membership from Nottinghamshire County Council Children Families and Cultural Services and. Nottingham North and East Clinical Commissioning Group (CCG) also send a member of staff to represent all the CCGs across Nottinghamshire (excluding Bassetlaw). 2

3 10. The CCG members of the Children s Trust Board may want to consider how best to engage with the teenage pregnancy strategy. The Teenage Pregnancy Integrated Commissioning Strategy Progress Update 11. The Teenage Pregnancy Integrated Commissioning Group published their strategy and action plan in January Using the evidence base of what works to tackle teenage pregnancy and local needs analysis, the following priorities were agreed: 1. Prevention of teenage conception and poor sexual health through contraception and sexual health service provision 2. Children and Young People have access to information and education about sexual health and relationships 3. The workforce has the skills, knowledge and confidence to help prevent teenage pregnancies and support young parents. 4. Improve outcomes for teenage parents and their children 12. The strategy is performance managed annually at the end of each financial year. Of the 12 actions listed under the priorities above the following table summarises their performance: Number of actions Progress Rating Behind or not happening work has not started when scheduled or has started but activity is not meeting or unlikely to meet its milestones Happening but behind schedule work has started but activity is not meeting milestones, but is expected to by the deadline if adjustments are made On schedule work has started and is meeting milestones Completed work has been successfully completed to deadline No judgement possible 13. Details of the progress against each action are included in Appendix One of this report. 14. It is interesting to note that services soon to be commissioned by the Local Authority through are not systematically collecting and sharing performance data with commissioners. We do not have for example data regarding young service users accessing sexual health services and the outcomes for them. 15. The action plan associated with the Teenage Pregnancy Integrated Commissioning Strategy has been updated to reflect the previous year s performance and changes in service developments. The refreshed strategy has been circulated with papers and the priorities for are summarised in Appendix Two. 3

4 Teenage Conception Rates 16. Nottinghamshire historically has achieved well in reducing teenage conceptions, comparing well with statistical neighbours and across the region. The teenage conception rate is calculated by identifying the number of conceptions per 1,000 females aged in an area. Under 16 conception data is also provided but is not used to assess progress nationally so has not been used in this report Teenage Conception Data is measured annually and the annual teenage conception rate for under 18 s has been the main target for teenage pregnancy strategies and Children s Trust partnerships. The latest annual data published is for Teenage Conception data is provided by the Office of National Statistics (ONS) and the Department of Health (DH) in February each year. 18. The 2011 under 18 conception rate for Nottinghamshire was 31.9 per 1000 females aged compared to 46.4 in 1998, the teenage pregnancy strategy baseline year. 19. The number of under 18 conceptions in 2011 was 451, a reduction of 163 from the 1998 baseline number of 614. It is useful to see the number of teenage conceptions over the years. Figure 2: Numbers of Teenage Conceptions across Nottinghamshire Numbers of Teenage Conceptions for Nottinghamshire Number of under 18 conceptions Year 20. Nationally it is estimated that 20% of all teenage conceptions are repeat conceptions, this is similar to Nottinghamshire levels. 1 Detailed analysis of teenage pregnancy data is included in the refreshed edition of the JSNA

5 District Level Data It is also important to assess the progress of reducing teenage conceptions across Districts. Figure 3: 2011 District level teenage conception data for Nottinghamshire and Districts Number of Conceptions Conception rate per 1,000 women in age group Maternity rate per 1,000 women in age group Abortion rate per 1,000 women in age group Percentage of conceptions leading to abortion Nottinghamshire % Ashfield % Bassetlaw % Broxtowe % Gedling % Mansfield % Newark and Sherwood % Rushcliffe % Figure 4: Nottinghamshire and District Teenage Conception Rates Teenage Conception Rates by Locality 50.0 Conception rate per 1,000 females aged years Nottinghamshire Ashfield Bassetlaw Broxtowe Gedling Mansfield Newark and Sherwood Rushcliffe Locality 5

6 Figure 5: Teenage Conception Rates for Nottinghamshire and its seven Districts Teenage Conception Rates for Nottinghamshire and Districts Teenage Conception Rate Year Nottinghamshire Ashfield Bassetlaw Broxtowe Gedling Mansfield Newark and Sherwood Rushcliffe 22. Teenage conception rates are increasing for a number of districts including Ashfield, Mansfield and Rushcliffe. Hot Spot Wards across Nottinghamshire 23. The wards listed below are included in the 20% of wards in England with the highest teenage conception rates (at least 58.4 conceptions per 1,000 women aged 15-17). Please note that the population estimates used as the denominator in these rate calculations are estimates of the population of year old females by ward, aggregated over a 3 year period. Some wards have small populations of women in this age group: rates for these wards fluctuate from year to year and the area may not be one with a high incidence of teen pregnancy. For this reason wards where the rate is not significantly different from the England average (41.0 conceptions per 1,000 women aged 15-17) are excluded from this list. Figure 6: Nottinghamshire Wards in top quintile for Under 18 conception rates, England, Hucknall East Ashfield Kirkby in Ashfield East Kirkby in Ashfield West Ranskill Bassetlaw Worksop South East Carlton Killisick Gedling Netherfield and Colwick Valley Mansfield Eakring Portland 6

7 Newark and Sherwood Broxtowe Ravensdale Sherwood Bridge Castle Devon Eastwood South Stapleford North How we compare with others 24. In 2011, Nottinghamshire s teenage conception rate (31.9) was slightly higher than the England (30.7) and East Midland (31.3) rate despite having lower rates for nearly ten years. 25. Since the end of the national Teenage Pregnancy Strategy, the 1998 baseline is not used to assess progress in reducing conception rates as national targets have ended. 26. The Nottinghamshire Teenage Pregnancy Integrated Commissioning Group has not set forward trajectory targets to reduce teenage conceptions but has decided to compare progress in reducing teenage conceptions against regional and national rates and progress of statistical neighbours. Local Authority Children s Service statistical neighbours are used when comparing teenage conception rates. 27. The graph below indicates that Nottinghamshire is on par in terms of their performance to reduce teenage conception levels with statistical neighbours. However only Lancashire has a higher teenage conception rate than Nottinghamshire. Figure 13: 2011 Teenage Conception Rates for Nottinghamshire and Statistical Neighbours 2011 Teenage Conception Rates across Nottinghamshire and it's Statistcal Neighbours Teenage Conception Rate England East Midlands Nottinghamshire Derbyshire Lancashire Cumbria Staffordshire Source: ONS

8 28. The reduction in Nottinghamshire s teenage conception rate is starting to slow down and for the first year our rates are worse than the national and regional teenage conception rate. It is unclear however why the rate is not continuing to decline and it will be important to assess this over a longer period of time. 29. The latest published teenage conception data is from It is important to acknowledge that the Nottinghamshire Teenage Pregnancy team ended in 2011 and the local profile of teenage pregnancy work reduced after this time. It is suggested that greater awareness is required to ensure that practitioners know how to access free training, engage with the C-Card scheme and have the knowledge to signpost young people to appropriate services such as Contraception and Sexual Health. In addition to providing up to date information directly to young people about relationships, sexual health and local services. 30. The Teenage Pregnancy Integrated Commissioning Group has a budget of 80,000 a year to commission the C-Card condom scheme and the Teenage Pregnancy Programme. Members of the group are keen to see an increase in the budget to increase work to promote services, interventions and raise awareness amongst children, young people, families and practitioners across Nottinghamshire. RECOMMENDATIONS 1) The Children s Trust Board notes the content of this report and acknowledges the progress made in relation to the implementation of the Integrated Commissioning Strategy and the reduction of teenage conceptions. 2) The Children s Trust Board ratifies the refreshed Teenage Pregnancy Integrated Commissioning Strategy included in the papers for the Children s Trust Board. 3) The Children s Trust Board considers how best Clinical Commissioning Groups want to engage with the Teenage Pregnancy agenda and Integrated Commissioning Group. 4) The Children s Trust Board discuss identifying additional funding to support the communication and engagement elements of the teenage pregnancy strategy. Irene Kakoullis Senior Manager, Nottinghamshire County Council For any enquiries about this report please contact: Irene Kakoullis Irene.kakoullis@nottscc.gov.uk

9 Background Papers Except for previously published documents, which will be available elsewhere, the documents listed here will be available for inspection in accordance with Section 100D of the Local Government Act Refreshed Teenage Pregnancy Strategy and action Plan attached to this report. Teenage Pregnancy section of the JSNA 2013 (soon to be available at 9

10 APPENDIX ONE Performance of the Nottinghamshire Teenage Pregnancy Integrated Commissioning Plan Actions/ Prevention of teenage conception and poor sexual health through contraception and sexual health service provision. Milestones Successful delivery of the C-Card condom Scheme with increased number of new registrations and return users in particular from hot spot wards and amongst at risk groups. Young People Friendly Contraception and Sexual Health (CaSH) services are accessible and well utilised by young people across Nottinghamshire, in particular for those in hot spot wards. Resource Implications 40,000 pa Early Intervention Grant Plus additional 6,000 in 2013/14 (Public Health contribution) PCT budgets LA (Public Health budget) Commissioning Leads / Link Irene Kakoullis Tracy Burton / Kazia Foster Related Strategies and Local Plans Framework 2012 Young People s Service Business Plans 2011/12, 2012/13 and 2013/14 Framework 2012 RAG rating (see end of docum ent) Performance The C-Card scheme progresses well with a new lead identified through the Youth Service. Baseline data from the scheme was inaccurate so after data cleansing it became apparent that targets were unrealistic. Targets for 2012/13 have not all been achieved because of inaccurate baseline data. New targets have been set for 2013/14. Additional funding has been secured for 2012/13 and 2013/14 to increase the hours of the C- Card co-ordinator. There is no judgement possible for this milestone because performance data from some CaSH services is not routinely shared with commissioners as part of the information schedule. The performance team will enforce. Plans for Young People Friendly Services however are underway. 10

11 Actions/ Children and Young People have access to information and education about sexual health and relationships The workforce has the skills, knowledge and confidence to help prevent teenage pregnancies and support young parents. Milestones Increased number of schools achieving the Healthy Schools Enhancement model as measured through performance systems (with a particular focus on the SRE and TP elements). Mainstream Youth Service provision of informal SRE and signposting through the core offer of the C-Card Scheme across 28 YP's Centres and 10 Mobile Units. Successful delivery of Sexions in Ashfield and Mansfield Successful delivery of the Teenage Pregnancy Training programme measured through annual evaluation. Resource Implications budget Mainstream delivery through LA Budget NHS Nottinghamshire County ,655 pa 40,000 pa Early Intervention Grant Commissioning Leads / Link Irene Kakoullis Chris Warren Tracy Burton Irene Kakoullis Related Strategies and Local Plans Framework 2011 YP's Service Business Plans 2011/12, 2012/13 and 2013/14 Framework 2011, 2012 Framework 2011 RAG rating (see end of docum ent) Performance Increasing numbers of schools are engaging in the enhanced healthy schools model; however the uptake of schools focusing on SRE is very low in comparison with other priority health topics. SRE (4 schools), Emotional Health and Wellbeing (82), drugs - including smoking and alcohol (11), Obesity and healthy eating (42). Each unit offers the C-Card scheme and informal SRE. Youth Workers continue to access training in high numbers. Sexions has been commissioned to work across Mansfield as well as Ashfield. However performance data is not routinely shared as yet, because this is a very small element of a very large block contract with an Acute Trust. The teenage pregnancy training programme continues to attract multi-disciplinary groups. The programme however has had a substantial number of cancelled places and no shows which has resulted in the training leads now charging for non attendance 11

12 Actions/ Improve outcomes for teenage parents and their children. Milestones Pregnant teenagers and teenage parents have access to good quality ante natal and post natal health care that is responsive to their needs. School aged pregnant young women and parents are supported to access inclusive education support packages. Increased uptake of Children Centre services by teenage parents with a particular focus on under 19's. Resource Implications PCT budgets (part of block Contracts) LA budget 2012/13 81,000 Early Intervention Grant 2011/14 part of core service provision Commissioning Leads / Link Jenny Davies / Kazia Foster Chris Harrison Justine Gibling Related Strategies and Local Plans Frameworks 2011, 2012 Health Visitor Implementatio n Plan. SEND Business Plans , and Early Intervention Strategy RAG rating (see end of docum ent) Ongoin g since April12 Performance which will also help to bolster funding for the training. Some professional groups still require further targeting e.g. school nurses and Targeted Youth Support staff. A training needs assessment was completed in May NUH Maternity Service Review incorporates current access and care pathways for Pregnant Teenagers. Plans for SFHFT Maternity Service review this year which will inform Service Specification and Contract 13/14. Work in partnership with LA and third sector agencies to improve access to antenatal care. 14 Pregnant Learners / School Aged Mothers currently supported at 7/1/13 throughout the County. Individualised packages being commissioned and overseen by school using mainly First Class, and Beckhampton has also been commissioned when school felt it was appropriate. 764 teenage mothers (under the age of 20) were accessing Children Centres across Notts in 2011/12 (baseline data not provided however so it has been a challenge to judge if this action 12

13 Actions/ Milestones Resource Implications Commissioning Leads / Link Related Strategies and Local Plans RAG rating (see end of docum ent) Performance has been achieved). Scoping the development and implementation of the Family Nurse Partnership (FNP) to establish the programme across Nottinghamshire from 2012/13. Improvement of outcomes for Teenage Parents accessing Targeted Youth Support Service (including supported accommodation). Funding allocations to be confirmed. Early Intervention Grant part of core service provision Kate Allen/ Sue Gill / Derek Higton Laurence Jones Framework 2012 TYS and Youth Justice Business Plan 2011/12 The funding for the FNP has been secured and a provider commissioned. Staff recruitment is complete and the programme started in January Performance reports will be received every 6 months to the TP ICG. Targeted Youth Support Services have maintained support for homeless pregnant teenagers and teenage parents through the commissioning of Supported Accommodation providers. Strong links have also been made with the Family Nurse Partnership in Nottinghamshire. Behind or not happening work has not started when scheduled or has started but activity is not meeting or unlikely to meet its milestones Happening but behind schedule work has started but activity is not meeting milestones, but is expected to by the deadline if adjustments are made On schedule work has started and is meeting milestones Completed work has been successfully completed to deadline No judgement possible 13

14 APPENDIX TWO Teenage Pregnancy Integrated Commissioning Priorities for Prevention of teenage conception and poor sexual health through contraception and sexual health service provision Successful delivery of the C-Card condom Scheme with increased number of new registrations and return users in particular from hot spot wards and amongst at risk groups. Enforcement of the Information Schedule in order to obtain appropriate data from Contraceptive and Sexual Health Services (CaSH) Health Services across Nottinghamshire are assessed as being Young People Friendly by young people. Contraception and sexual health services are Young People specific across Nottinghamshire 2. Children and Young People have access to information and education about sexual health and relationships Increased number of schools achieving the Healthy Schools Enhancement model as measured through performance systems (with a particular focus on the SRE and TP elements). Mainstream Youth Service provision of informal SRE and signposting through the core offer of the C-Card Scheme across 28 YP's Centres and 10 Mobile Units. Data requirements for Sexions service specification to be included into the information schedule for Sherwood Forest Hospital Trust. Explore the expansion of Sexions into Newark and Sherwood. 3. Workforce Development Successful delivery of the Teenage Pregnancy Training programme measured through annual evaluation. 4. Improve outcomes for teenage parents and their children Pregnant teenagers and teenage parents have early access to Antenatal care and good quality Antenatal care throughout their pregnancy that it is in a variety of settings and young people friendly. Decrease the number of pregnant teenagers that smoke during pregnancy. Increase the number of pregnant teenagers and teenage families that enrol in the Healthy Start Programme to improve nutrition and Vitamin D uptake. Increase the number of pregnant teenagers that initiate breast feeding and sustain breast feeding at 6-8 weeks post delivery. Teenage parents have good quality postnatal care and have adequate support in the postnatal period to meet their needs and their baby s needs. School aged pregnant young women and parents are supported to access inclusive education support packages. Increased uptake of Children Centre services by teenage parents with a particular focus on under 19's. Successful implementation of the Family Nurse Partnership ensuring all targets are achieved. Successful move on for Teenage Parents who have accessed supported accommodation supported by Payment by Results for providers. 14