The Health and Wellbeing Board is asked to consider the 0-5 Joint Strategic Needs Assessment (JSNA). Authority is sought to publish the 0-5 JSNA and the development of an associated action plan that will be monitored by the JSNA Strategic Group.

Duncan Vernon, Public Health Consultant introduced the Children’s 0-5 Joint Strategic Needs Assessment (JSNA). It looked at the health needs of children aged 0-5 in Warwickshire and was aligned with ‘The Best Start for Life policy vision’ of 1,001 critical days for lifelong emotional and physical health, health needs during pregnancy and maternal health. Sections of the report focussed on:

• Local context, including the predicted population growth, ethnic diversity and impacts of deprivation.
• Health of children 0-5 – pregnancy and birth. This included parenting education, low birth weight and obesity, smoking in pregnancy and mental health data.
• Health of children 0-5 – early years. Improving data collection on breast feeding, data on childhood obesity, visually obvious tooth decay, vaccine coverage and issues associated with domestic abuse.
• Child hospitalisations. Findings from different waves of the pandemic, by area, gender, indices of deprivation and ethnicity. Further aspects on unintentional injuries, emergency admissions and reducing unintentional injuries, focussing on five key causes.
• Child deaths. This section covered key causes, the relationship to wider determinants of health and data on the 122 Warwickshire child deaths over the period 2017-21.
• Services for children 0-5. This reported on the proportion of new birth visits, infant reviews and the feedback from parents and carers of young children of the 0-5 public health nursing service. Further aspects on early education and childcare, school readiness and achieving a good level of development. There were known links between deprivation and school readiness. Reference to the WCC early years needs assessment, its data findings and those from the Joseph Rowntree Foundation. This section also outlined the support from Children and Families Services, with data on specialist help, early intervention and outreach services.
• Report recommendations. Six areas were outlined. These concerned increasing population growth and increasing diversity of needs, that deprivation and inequalities were a critical factor and there were key health promotion issues for all services to embed. There were opportunities to increase the role of early intervention and prevention, a need for closer alignment between services and an opportunity to establish a partnership to centralise the needs of children and to take forward the recommendations within the report.
• JSNA prioritisation. A two-year thematic work programme had been developed and was set out in the report. Some aspects had been completed. With the wider development of the ICS, it was proposed to undertake a further prioritisation exercise and the suggested approach was outlined.

A presentation was provided to pull out the key aspects of the report, based on the sections detailed above. Questions and comments were invited, with responses provided as indicated:

• The Chair praised the report and the detailed data it contained.
• Concern about drowning risks increasing due to the reduction in numbers of children learning to swim. This had been impacted by both the pandemic and potentially pool closures associated with increasing costs of heating them. 
• The report contained a wealth of information. A concern that the gaps related to deprivation were widening. Points about the lack of a consistent geography as the areas covered by each JSNA differed from those served by the corresponding family centre. A need to join this up and to share data.
• There was concern about unintentional hospital admissions and cases of neglect. A question on how this was mapped from the various data sources available to ascertain levels of neglect.
• Regarding the focus on 0-5 services, this should be extended to include the period from conception. There was potential for more early intervention work and provision of information at an earlier stage. Otherwise, the known gaps in child development were likely to widen still further.
• The detailed action and delivery plans would be key and needed to show how they linked to the various other strategies.
• A comparison was drawn to a similar document from 2018, with virtually the same themes, but this report showed an increase in the gaps referenced above.
• Duncan Vernon responded to the points above. He referred to the risks of smoking in pregnancy as an example where the focus on conception to five was relevant. There were initiatives within the NHS long-term plan to encourage smoking cessation amongst pregnant women. The NHS and WCC worked together on such initiatives. He noted the important points around neglect, speaking about early help, the available, granular data, some of which was new. This wealth of data would enable comparison between services, making the case for closer partnership working and aligning geographies too.
• There was an important role for health visitors to identify potential issues at an early stage. Some people were not aware who their health visitor was. The Chair responded that this was another example where partnership working could ensure that services complemented each other. Jagtar Singh noted the points raised and the need for assurance. There were a number of challenges for the health visiting service, due to the pandemic and growing service demand. His trust used a ‘patient story’ approach to provide more information via videos of services and one could be produced for this service. He offered to meet with the councillor outside the meeting. This offer was welcomed, and a further concern was not having consistent health visiting staff. Jagtar Singh gave an example of attending a health visit, the challenges observed and need for wider interventions from other services to assist that individual.
• Chris Bain noted that the presentation made reference to risk factors, which included ethnicity and further context on this was sought. It was a complex picture and in areas of deprivation there tended to be a greater diversity of ethnicities. Duncan Vernon spoke about challenges in access to services, for example where English was not the person’s first language and also outcomes from accessing services. Chris Bain viewed this as significant, as reducing health inequalities was a key driver of integrated care. Access to services was essential to tackling inequalities and it was questioned if work was taking place to look at both provision of services and outcomes to start to tackle such health inequalities. A further response was provided about population health management and the potential uses of this data as the Integrated Care System became established. Duncan gave an example of the work that provider trusts were doing towards the NHS long term plan aims around continuity of care for maternity services for expectant mothers from BAME backgrounds.
• Shade Agboola provided further information about the system response to address health inequalities, formulating a plan which had involved robust engagement with a variety of bodies. She spoke about the NHS Core 20+5 model which had been discussed at a previous board meeting. This identified the twenty percent most deprived population and certain ‘plus’ groups. In Warwickshire one of the plus groups within the Systems Inequalities Strategy recognised that ethnically diverse populations were disproportionately impacted and would experience health inequalities beyond those of most of the population. This plan would shortly be submitted and be followed by implementation. 
• Councillor Roodhouse spoke about the process aspects and the work taking place in several different forums, including at ‘place’. He gave examples of the different bodies involved and asked if there was a role for the WCC Children & Young People Overview and Scrutiny Committee (the OSC) to also keep an oversight and hold the system to account.
• Nigel Minns agreed that there was a need to be clear about the functions of the different groups. In his view, the OSC had a role to hold services to account. Health visiting was a service commissioned by WCC, so the OSC could ask for performance information, or a suggestion be made by the board for it to seek such an update. Thereafter, the OSCs findings about any service gaps or concerns requiring partners to work together could be fed back to the Board. He spoke of the role of the Board and those areas within this report which could be included within the terms of reference for the proposed Children’s sub-group.
• Stella Manzie noted the higher rate of injuries involving children in Rugby. She offered to discuss this at UHCW to see if there had been any additional analysis. Stella also referred to a recent visit to UHCW by Danielle Oum, the ICS Chair. One of the areas discussed was the neonatal outreach service being provided by the three acute trust hospitals. This enabled very young babies to be discharged from hospital earlier, with substantial care and support packages at home. It was seen as a very positive development and had been well received so far.
• Nigel Minns referred to the Covid vaccination programme and the vocal opposition nationally by some people to the vaccination. He asked if this had reflected on uptake of other vaccination programmes. Duncan Vernon considered it was too early to tell and said there were slight differences in the delivery of other vaccines. The current public awareness of vaccinations may provide an opportunity for messaging and would be something the proposed children’s sub-group could consider.

Resolved

That Health and Wellbeing Board:

1. Notes the contents of the 0-5 Joint Strategic Needs Assessment (JSNA).

Approves the publication of the 0-5 JSNA and the development of an associated action plan that will be monitored by the JSNA Strategic Group and the proposed new Children’s group.