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Fit for and During Pregnancy: a Key Role for Local Government

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Fit for and During Pregnancy: a Key Role for Local Government Fit for and during pregnancy A key role for local government Case studies Acknowledgements Thank you to Public Health England (PHE) for the use of their infographics and to Dr Anna Lucas, Maternity Transformation Programme (MTP) Manager and her team for their input on this publication Contents Foreword 4 Introduction 5 Focus Areas 8 Key facts and figures 10 Top tips for success 12 Case studies 14 Barking and Dagenham and Havering 15 Brighton and Hove City Council 17 Bristol City Council 19 Camden Council 22 Cornwall Council 24 Gloucestershire 26 Greater Manchester 28 Halton Borough Council 30 Leicestershire County Council 32 Lewisham Council 34 Lincolnshire County Council 37 Rotherham Metropolitan Borough Council 39 Sheffield City Council 41 West Sussex County Council 43 Want to find out more 45 A key role for local government 3 Foreword It is easy to think responsibility for the health In this report, you will find examples of health of pregnant women and infants lies with visitors, family workers, midwives, social care the NHS because of its role in delivering and children’s centres staff helping families maternity and neonatal care. But the influence through this vital period as well as areas of local government through its public health experimenting with a new local government role role and wider responsibilities is huge. of consultant public health midwife. Whether it is supporting stopping smoking, For example, in Gloucestershire a new encouraging healthy eating, protecting good integrated pathway has been created to ensure mental health, or delivering universal or everyone from midwives to psychiatrists are targeted health visiting services or simply working in a coordinated way. Meanwhile, in working closely with the NHS - councils have Cornwall a comprehensive healthy weight offer a significant role to play. has been developed to work with pregnant women on healthy eating and exercise. Nearly 700,000 babies are born every year in England and Wales. That means at any one time Digital approaches are also at the forefront. approximately one in 15 adult women under An online portal – Family Assist – has been the age of 50 are in what is called the perinatal launched in West Sussex to support women period – either pregnant or in the first year of through pregnancy and into motherhood, motherhood. It is a crucial time for both mother while Greater Manchester is piloting a new and child. For babies, this period has a major app to help keep parents informed about influence on their physical, social, emotional local services. and language development. For women, and men this life-changing event means they require We should not forget fathers either. Their support and care in a range of different ways. health and wellbeing is also crucial – yet For many, pregnancy may be the first time they research suggests many feel marginalised have had sustained contact with health and by the agencies they come into contact council services and so it presents the ideal with. In Leicestershire and Lincolnshire local opportunity to influence their lifestyles and government has led the way in developing maximise their health and wellbeing. new ways of working with fathers in mind. Councils through the 0-19 Healthy Child To keep the momentum going, PHE has Programme play an instrumental role in leading published a suite of free resources called in the delivery and coordination of support Health Matters: reproductive health and 1 across a number of partners to ensure there pregnancy planning available to councils is early access to support for women and their and their partners to use. If we can build on partners, not only during pregnancy but to what is being achieved we will have a major plan and prepare for pregnancy and support impact on both adults and children. them in the early weeks and years after birth Councillor Ian Hudspeth and throughout the school years. Chair, Community Wellbeing Board Councils, in partnership with the health service, are working hard to support mothers and fathers. 1 www.gov.uk/government/publications/health-matters- reproductive-health-and-pregnancy-planning/health- matters-reproductive-health-and-pregnancy-planning 4 Fit for and during pregnancy Introduction Helping women to improve their health and Taking an upstream approach the reduce risks prior to pregnancy will help to preconception period presents an opportunity ensure that they have healthier pregnancies, for intervention, when women and men can and that their babies have the best start in change certain lifestyle choices in preparation life. There has been much national focus in for a healthy pregnancy. recent years on the 1,001 days between a pregnancy and the child’s second birthday, There are a number of actions that which offers a unique window of opportunity local government can take to support to build healthier and more prosperous preconception health, and better health futures. This has led to and been included in in the first 1001 days, working through a number of policy initiatives including the Local Maternity Systems (LMS) – set up Best Start in Life, the MTP, Tobacco Control by NHS England to bring together local Plan and Five Year Forward View for Mental commissioners and providers to deliver Health. effective services. Delivering integrated health visiting and maternity services to embed Notably, in 2015 the government set out its care and support for a healthy conception, ambition to halve rates of stillbirths, neonatal pregnancy and beyond will be key to this. deaths, maternal deaths and brain injuries by 2030. In 2016 NHS England’s Maternity Embedding a holistic approach to Transformation Programme2 was set up to prevention to improve women’s health deliver over five years the ambition set out before and during pregnancy will: in ‘Better Births’3. The programme seeks to • give every child the best start in life achieve safer, more personalised, kinder, professional, and more family-friendly • reduce health inequalities maternity services. PHE is one of the key • improve choice and personalisation delivery partners and is leading work to • achieve safer outcomes for all mothers prevent poor outcomes through actions to and babies. improve women’s health – focusing on before, during and after pregnancy to ensure families get off to the best start possible. Why is this important Many of the national initiatives mentioned for councils? above promote public health and early intervention, which local government staff Councils have a vital role to play in improving and services in contact with women during population health and tackling health this time can play an important part in inequalities, because many of the behavioural, to embed care and support for healthy social and economic determinants of health conception, pregnancy and beyond. and services or activities which can make a difference fall within their remit. The challenge is to improve health and wellbeing in the whole local community, and to reduce variation 2 www.england.nhs.uk/mat-transformation/saving-babies/ experienced between deprived and wealthier 3 www.england.nhs.uk/wp-content/uploads/2016/02/national- areas. maternity-review-report.pdf A key role for local government 5 In its wide ranging review of the impact of The 0-5 HCP which includes the health visiting health inequalities in England, the ‘Marmot service and the Family Nurse Partnership Review’4 (2010) estimated the cost to the transferred from the NHS to local government health care system alone of treating illness on 1 October 2015. This completed the and disease arising from health inequalities at transfer of public health duties to local £5.5 billion per year, with additional service and government set out in the 2012 Health and social care costs borne by local government. Social Care Act and joined up commissioning One of the key recommendations for improving for the 5-19 Healthy Child Programme which population health and tackling health inequality transferred to local government in 2013. from the Marmot review, supported by the All Party Parliamentary Group for Conception to The 0-5 HCP is a universal programme Age Two, was to ‘give every child the best start delivered by health visitors. It includes extra in life’. Local government shares this ambition levels of help and support to those families – in 2017 88 per cent of lead members of that need it (see service model below). All public health said ‘giving children the best families are offered the core elements of the start in life’ was one of their top priorities (Local programme which includes five mandated Government Association (LGA) Public Health health and development reviews (antenatal Perception Survey,5 2017) health promoting visit, new baby review, 6-8 week assessment, one year review and The 0-5 Healthy Child Programme (HCP) which two – two and half year review), screening, falls under local government’s responsibilities immunisations, social and emotional is a key vehicle for realising this ambition. development support for parenting and health promotion activities. Figure 1: The new service model for the 0-19 Healthy Child Programme 4 www.instituteofhealthequity.org/resources-reports/fair- society-healthy-lives-the-marmot-review/fair-society- healthy-lives-full-report-pdf.pdf 5 www.local.gov.uk/public-health-perceptions-survey 6 Fit for and during pregnancy Delivering the vision ‘to give every child the best start in life’ requires local leadership and action. This requires closer working between professions such as health visiting services and maternity services and taking a ‘whole system approach’ to change. To support this approach, forty-four LMS were set up in 2017 to bring together health and public health commissioners and providers together with wider stakeholders and service users to deliver local transformation. The national drive presents an exciting opportunity for local areas to come together to commission integrated local needs-based care pathways for key public health services.
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