APPENDIX 1 - Enfield Mortality... · Project quarterly report 2.3 Strengthen ... Enfield NHS Enfield A project lead has been ... (also approach Royal College to include in

APPENDIX 1

INFANT MORTALITY ACTION PLAN 2010

1. STRENGTHENING LOCAL DELIVERY (Cath Fenton)

Policy objective

Actions Area lead/key stakeholder

Resources1 Progress measure and key dates

1.1 Establish a local understanding of causes of death in those aged under one

Review local causes of death in the under 1s to identify major causes and trends via the Child Death Overview panel and analysis of death files to inform potential points for intervention and prevention

NHS Enfield Public Health Child Death Overview panel

Use CDOP data on an ongoing basis to add depth to ONS data; 2009/10 to be reviewed by summer 2011.

Undertake a health equity audit to understand reasons for late maternal booking

Service design team

HEA to be completed by December 2010; preliminary HEA carried out which identified geographical areas and ethnic groups where late booking was common. Lead for this has now left PCT

1 From existing budgets and resources.

Policy objective



1.2 Improve services for local Communities

Information has currently highlighted geographical areas of deprivation. Further analysis to identify target groups with highest IMR using data available from CDOP. Identify clear strategy for development of services to support needs of target groups and geographical areas

Public Health/CDOP Infant Mortality Working Group

Translated materials to be available by end 2010/11; no budget to undertake translation. However health champions are promoting key public health messages with parenting & community groups

1.3 Raise awareness of the Infant Mortality strategy and action plan with key stakeholders

Develop a communications plan to promote the key actions that are most likely to contribute to the target and improve outcomes for mothers and babies; ensure high level partnership support and sign up to the Action Plan.

NHS Enfield Public Health Departments

Communications plan to be completed by end 10/11. Strategy/action plan to be discussed at Children’s Trust 2010. Under 5s health training being provided by NHS Enfield. Communications also via Protected Learning Time sessions with GPs

Policy objective



1.4 Raise awareness of methods of reducing infant mortality

Development of credit card style information containing key messages around infant mortality for health and social care professionals. Use of safeguarding DVD to be shown in GP surgeries.

NHS Enfield & Haringey Public Health Departments NHS Enfield Public Health

£70 £1k

Card developed and distributed by early 2010; presented at CT Conference Feb 2010. cards distributed by Enfield Community services & a range of partners – highlighted in recent DH inequalities document as good practice. DVD shown August/September 2010 & January 2011

Encourage organisations providing training to child carers to include information on infant mortality

Local authority & Informed Families

Under 5s training provided to local authority personnel November 2010 (with 2 further sessions planned 2011)

1.5 Improve data quality

Create an infant mortality dashboard to monitor progress on proxy measures. Use data on proxy measures to inform the construction of a trajectory for infant mortality

NHS Enfield Public Health

Strategist time

Exploring construction of Infant Mortality dashboard – to be completed Autumn 2010 Dashboard completed

Policy objective



1.6 Improved monitoring arrangements to assess progress in reducing infant mortality

Establish Child health group to oversee implementation of Action Plan as part of the monitoring of the Children and Young People’s Plan. Update the Children’s Trust Board regarding progress.

NHS Enfield Public Health

Child health group to be established by end 2010 Child health steering group established 2010, plan to hold a themed infant mortality session in 2011

2. TEENAGE CONCEPTIONS AND TEENAGE PARENTS Nursal Livatyali

Policy objective

Action Area lead/key stakeholder

Resources Progress measure and key dates

2.1 To promote the health of teenage parents

Ensure actions to support young parents are delivered and monitored.

• All teenage parents referred to Young Parents Project (YPP) given support and details of contraception (including LARC), smoking cessation and stopping alcohol and drug misuse.

• Smoking cessation team and drugs advisor attend support group quarterly. Project NNEB to train as smoking cessation councillor

• Outreach work to support emotional health of teenage mothers; “Listening 2U” counselling service established.

Ensure services are welcoming and involve young fathers; information pack being developed by YPP for distribution to young fathers

Young parents project (referrals from HVs and SNs) Young fathers project & YPP

Performance management of use of these specialist services via TP subgroup (meets every 2nd month) TP meetings to be reviewed in 2011

North Middlesex Hospital to explore the appointment of a lead teenage parents and substance misuse midwife.

NMUH 2010-11

Policy objective



Explore ways to establish a peer support programme with teenage parents to cover a range of issues such as breastfeeding, smoking cessation etc.

YPP 2010-11 Exploring funding for breastfeeding peer support training ongoin

2.2 Strengthen information base around teenage parents

Improve data collection and sharing to ensure that services are aware of where teenage parents are to ensure timely and effective support. Midwifery services to refer to YPP Ensure births to teenage mothers and termination data is regularly shared with Teenage Pregnancy Partnership Board. Ensure all professionals are confident, routinely using CAF to gain a holistic assessment and to share information appropriately with other professionals. Ensure ongoing liaison with Safeguarding Midwife, dedicated Teenage pregnancy midwives and Young Parents Project

Young parents project, & Town Clinic Teenage pregnancy coordinator Further training and support is available from the Integrated Support Service Child Protection/ Midwives at NMUH &BCF

Review wording of existing SLAs/ contracts

Prescribing data & comparative rates for LARC and Emergency Hormonal Contraception. Comparative termination data showing early NHS access, repeat termination data; Sexual Health Needs Assessment compiling this data currently in draft, to be finalised by March 2011

Increased use of CAF

Young Parents Project quarterly report

2.3 Strengthen partnership support for teenage parents

Establish clear lines of accountability with services working with teenage pregnancy and teenage parents to ensure all key stakeholders are aware of roles and responsibilities.

Teenage Pregnancy Co-ordinator, Young Parents Project Manager

Reminder at multidisciplinary meeting August 2010. Also highlighted at TPPB every 2 months

Policy objective



Development of training programmes through 14-19 strategy for pregnant teenagers & teenage parents

• Young Parents Project NNEB Module

• Keep it Simple training 12-week course. Preparing antenatal teenage mothers leading to NVQ

• Connexions attend Young Parents Project support group each week to offer advice and support.

• Care to Learn grant form distributed to all YPP referrals.

Teenage Pregnancy partnership

KIS Training stats Connexions Care to Learn grant uptake All teenage parents known to services to have education or employment plans (where appropriate) and access to accredited training programmes

Teenage Parents task group to be set up to ensure the following:

• Our local care pathways are up-to-date

• All pregnant teenagers and teenage mothers are supported to continue with their education, training or employment.

• All pregnant teenagers seen by midwives and health visitors are referred to Connexions to achieve the latter.

TP coordinator

First meeting held on 27 August 2010, 2-4pm, Civic Centre, Room 6

Policy objective



2.4 Ensure services meet the needs of teenage parents and are young people friendly

Identify project manager to lead on the process of assessment for the “You’re Welcome” standards for key services. Introduce standard into Enfield

NHS Enfield

A project lead has been identified in NHS Enfield. They will then set milestones for adoption and assessment towards the standard by end 2010-11. Unfortunately due to PCT reorganisation this person has now left.

Drop ins for teenage parents at the Foyer to encourage networking; reduce social isolation and promote information sharing. However current venue is unsuitable and so potential new location for service delivery is being explored.

Project manager, Young Parent’s Project

The number of teenage parents accessing drop ins and level of satisfaction with services is available via the YPP’s quarterly report. Evaluation of support group and group provision reported on biannually.

Introduce a new drop in at the Edmonton Youth Hub

2012-13

3. SMOKING CESSATION from 1st February 2011 the smoking cessation service in Enfield will be led by a new team & we will review these actions with them by month end

Policy objective



3.1 Smoking cessation to be an integral part of service delivery for whole family during and after pregnancy

Ensure appropriate level training is part of

• training programme for appropriate staff in NHS Enfield (i.e. those dealing with parents)

• Health Visitor training

• Midwives

• School nurses

• Student health professionals training/education (also approach Royal College to include in curriculum)

• Educational services which deal with teenage parents

• Children’s Centre staff training

Stop Smoking Service Service managers

Training provided free by Stop Smoking Service

Ongoing

Assessment of current access to training by above services.

Stop Smoking service

Report by September 2010

Policy objective



All pregnant women to be asked their smoking status at booking, throughout pregnancy and in post natal period. Status recorded and referrals made to Stop Smoking Service.

Maternity services Health Visiting Service Stop Smoking Service

Numbers of pregnant women who attend Stop Smoking Service referred from Hospital Trusts and Health Visiting Service.

Quarterly hospital data on smoking at time of delivery collected through Vital Signs Monitoring (VSMR)

Opt out service (all smokers automatically referred) brought in at North Middx, to be encouraged at BCF

Smoking cessation team attends Young Parents Project support group on a quarterly basis. NNEB to train as smoking cessation counsellor. Team attend 4YM lunch club.

Project Manager Project Midwife

Number of smokers amongst YPP attenders recorded.

Improve GP referral rates for pregnant women to the Stop Smoking Service.

Stop Smoking Service

Training offered to GPs by end 2010 Smoking booklet sent to all GPs by end 2010

Policy objective



Develop referral pathways for pregnant women to Smoking Cessation Service through other sources e.g. Pharmacists, Dentists and Children’s Centres. Ensure Children’s Centres Information Officers receive regular information from Stop Smoking Service

Stop Smoking Service (and Innovision for pharmacists)

Referral pathways in place for other professionals by end 2010.

3.2 Make the smoking cessation service more accessible and community based

Monitor usage to assess appropriateness of times of service etc.

Audit to be undertaken of languages spoken by Level 2 Advisors

Stop Smoking Service

Patient satisfaction with stop smoking services. Increased number of referrals and quitters End of year report

4. ANTENATAL CARE Emma Stevenson

Policy objective


Resources Progress measure

4.1 Improve access to effective and appropriate antenatal care

Consider use of group booking at NMUH (already at BCF); use of advertising to promote; feedback to GPs on referral patterns.

Emma Stevenson

Continued improvement in % of women booking for antenatal care by 12 weeks 6 days of pregnancy – measured by monthly hospital data (national target); responsibility for performance management of this has now moved to sector

4.2 Target women in routine and manual groups and other vulnerable groups to ensure earlier booking

Commission a Health Equity Audit of women booked by 12 weeks and after 22 weeks to identify inequalities in early booking and act upon recommendations

NHS Enfield

Service design are leading with support from performance management

Some practices with late bookers have been identified and visits made.

Develop more targeted community-based antenatal and post natal services to improve access to deprived and vulnerable communities Midwife available at YPP weekly support group for early booking and ongoing enhanced antenatal care.

Young Parents Project Project Midwife

Data of number of young mothers seen by midwife available at quarterly report.

Policy objective



4.3 Encourage use of local referral form by GPs and self referral for improved access to antenatal services

Raise awareness of, and accessibility to, antenatal services through:

• Advertising more widely routes to care in the community (i.e. with midwives or GPs) and the types of service available (screening, smoking cessation etc)

• Increasing venues at which booking can be undertaken in community (i.e. children’s centres, polysystems, Saturday sessions in hospitals etc)

• Self referral forms on Barnet & Chase Farm and North Middlesex Hospitals websites

NHS Enfield Barnet & Chase Farm North Middlesex Hospital;

Yearly review of any changes Service user feedback. Increase in number of women accessing antenatal care prior to 12 weeks 6 days of pregnancy.

4.4 Implementation of NICE Guidance on Antenatal Care

Ensure practice is guided by evidence of best practice.

North Middlesex Hospital; Barnet & Chase Farm hospital; NHS Enfield;

Guidelines implemented

Policy objective



4.5 Implementation of NICE guidance on antenatal and postnatal mental health

Recognise mental health problems during pregnancy and in the first year after giving birth and ensure systems in place to provide:

• care and treatment (including drugs and psychological treatments) of women who develop a mental health problem during pregnancy or in the first year after giving birth, and women who have a higher chance of developing a problem at this time

• care and treatment of women who already had a mental health problem before becoming pregnant

• how families and carers may be able to support women with mental health problems and get support for

North Middlesex Hospital Barnet & Chase Farm hospital Adult Mental Health/CAMHS NCL Acute Agency through Maternity Network

Midwives trained in using screening tool by April 2010. Mental Health Teams engaging with women at earlier stage in pregnancy. Develop Sector-wide Perinatal Mental Health Network by Sept 2010 as part of Maternity Network

Policy objective



4.6 Promotion of ante natal screening to identify potential problems at an earlier stage

Utilise annual screening audits to identify if inequalities exist in those accessing screening Engage with GPs to encourage early screening for sickle cell (ideally by 10 weeks of pregnancy or prior to considering a pregnancy). Liaise with Screening midwife to identify any emerging patterns in those who do not access screening.

Public Health NHS Enfield; North Middlesex Hospital; Barnet & Chase Farm hospital

Increased screening uptake – annual report September 2010; screening figures are monitored locally & at sector level. BCF currently have lower HIV screening rates than in other parts of the sector

4.7 Use of Common Assessment Framework

Promote the use of CAF to improve liaison with other agencies; highlighted to contracting team for inclusion in 2010/11 acute contracts.

North Middlesex Hospital Barnet & Chase Farm Hospital NHS Enfield

Monitor referrals with a view to tightening contractual expectations for 2011/12; maternity contracts are being reviewed and set at sector level

5. POSTNATAL CARE Kathy Soderquist

Policy objective



5.1 Implementation of NICE Guidance on Postnatal Care.


Midwifery (North Middlesex Hospital, Barnet & Chase Farm Hospital)

Guidelines implemented and progress against guidance continually reviewed

5.2 Promotion and effective targeting of neonatal screening to improve outcomes

Clearly communicate to parents the purpose and benefits of neonatal screening e.g. physical examination at birth and at 6 weeks and newborn bloodspot screening and how these tests improve outcomes for babies.

Shared care with GPs; Midwifery (North Middlesex Hospital, Barnet & Chase Farm Hospital)

Regular, routine checking of bloodspot results (PPS & HVs). Annual audit of bloodspot results April 11 Bloodspot results are now checked by day 17 of a baby’s life

5.3 Implementation of NICE guidance on Effective Actions on initiation and duration of breastfeeding


North Middlesex Hospital; Barnet & Chase Farm Hospital;

NMUH guidance ratified February 2010 – reviewed every 2 years. Chase Farm midwives now have level 2 accreditation for baby friendly initiative

2 Unless otherwise stated, from existing resources.

Policy objective



5.4 Increase exclusive breast-feeding rates (e.g. first 6 months)

Recruitment of HV breastfeeding specialist. Part of their role will include the production of local breastfeeding policy. Recruitment of breastfeeding lead midwife to work towards UNICEF baby friendly status Ensure health visitors & midwives receive training based on the UNICEF UK Baby Ten Steps to improve breastfeeding maintenance.

ECS NMUH ECS, North Middlesex Hospital, Barnet & Chase Farm Hospital

NMUH to identify funds to recruit Training for HVs requested from Ed & development

Role recruited to by December 10; Breastfeeding training uptake

5.5 Improve data collection and information on rates of breastfeeding

Build on existing system for collating and analysing breastfeeding data using hospital computerised records and data collated from parent-held child health record

NHS Enfield Performance Team;

Quarterly hospital data on initiation rates & monthly GP, HV continuation data collected through VSMR

5.6 Implement Baby Friendly in acute trusts.

Explore ability to establish senior level strategy group to oversee implementation of Baby Friendly in Enfield. Acute trusts to work towards registering for the Baby Friendly certificate of commitment.

North Middlesex Hospital

Barnet & Chase Farm Hospital

Dependent on identifying funds to recruit breastfeeding lead midwife at NMUH Cost associated with Baby Friendly Accreditation

2010-11

Policy objective



5.7 Improve Maternal and Infant nutrition

Develop local delivery plans to implement NICE obesity guidance. Develop plans to help women with a BMI above 30 to lose weight by informing them of the risks and providing a structured programme of support that can be tailored to the needs of the individual and combines advice on healthy eating with regular, moderate physical activity. Promotion of Healthy Start and other healthy weight programmes to be targeted in disadvantaged communities via Children’s Centres; GPs etc. Healthy Start Grant form distributed to all teenage parents referred to the YPP

NHS Enfield Benefits agency distribute forms YPP

Referral pathway to be developed in 2010-11; the referral pathways are now to be led by the sector Uptake of Healthy Start vouchers; exploring how these can be expanded & promoted – vitamins are to be given out by NMUH maternity from 1/3/2011

Policy objective



5.8 Ensure health promotion messages are being targeted to the most vulnerable groups to achieve greatest impact in reducing infant mortality

Midwives and health visitors to reinforce and target ‘Back to Sleep’ campaign to reduce Sudden Unexpected Deaths in Infancy. Information to be made available in Children’s Centres, primary care and other places where people with young families attend.

NHS Enfield Health Visiting Service North Middlesex Hospital; Barnet & Chase Farm Hospital; GPs

Sleeping position is recorded as part of new birth visit. Information to be disseminated to staff at trust wide meeting (July 26th

2010). Staff already give advice. Under 5s health training covers initiatives to reduce infant mortality, including a talk by a colleague from the Foundation of Sudden Infant Deaths.

Assess best methods of providing information (eg via ECEN, media promotions, GP surgeries “Life Channel”, Informed Families website etc.)

Julia Mills Assessment of information sharing best practice.

Provision of NHS Direct cards to all new parents

Midwives, health visitors

Already given to all new teen parents.

Policy objective



Parent engagement panels (PEP) will have focus groups with Parent Champions within each CAP promoting breast feeding, immunisation, safer sleeping etc.

Anne Stoker Set up of PEP, identification of Parent Champions, 2011.

Practical baby care information provided by Young Parents Project NNEB team in liaison with FSID; demonstrations, teaching session on safe sleeping and literature provided.

YPP Project Midwife, NMH teenage parent midwife lead.

Data of number of young mothers seen by midwife available at YPP quarterly report.

Policy objective



Advice and support given to those who are expecting a new baby and have already experienced a SUDI;

• home visit is arranged at 32/40 to explain the scheme, offering a choice of weekly HV visits, symptom diary, baby scales for daily weight and apnoea monitor.

• a follow up visit at 36/40 with the named HV to give any equipment required, teach infant resus and go through 'Reduce the Risks'.

• Once delivered the GP is informed & a paed passport issued for the local A&E Dept.

CONI coordinator

CONI coordinator produces annual report

Policy objective



5.9 Increase uptake of Immunisations

Interventions to increase immunisation rates are targeted to those in greatest need. Information is readily available to explain the importance of immunisations through a variety of outlets including Children’s Centres; community organisations, GP surgeries and Health Visitors. Communicate widely about the Edmonton Walk In Service and the provision of immunisation services. A poster has been designed to advertise the immunisation services at the Walk in Centre. This will go out to health professionals and community centres around the borough in the New Year. Talks to Early Years Practitioners have enabled them to be more confident when giving information to new mothers. LAC nurse checks that all immunisations are up to date at their first medical and refers children if necessary. All unregistered children are encouraged to go and register with a GP as soon as possible and provided with the necessary information.

NHS Enfield Public Health Health Visiting Service Children’s Networks GPs Immunisation Co-ordinator

Increase in immunisations Quarterly data reported to HPA Data monitoring at GP practice level. Practice visits have been arranged to support lower performing practices, outreach sessions have been provided. A visit from the National Support Team will also help guide additional initiatives (March 2011)

6. IMPROVING HOUSING QUALITY AND REDUCING OVERCROWDING3

Sally McTernan

Policy objective



6.1 Establish links with Housing Department to raise awareness of links with Infant Mortality

Raise awareness with housing officers of risk factors and potential links between housing quality, overcrowding and infant mortality

Enfield Homes

Increase in awareness of Infant Mortality among housing staff.

Ensure Housing Strategy makes explicit links between poor housing and overcrowding and infant mortality

Public Health, Enfield Homes

Links explicit in Housing Strategy, 2011

Communicate strategy to Registered Social Landlords, Enfield Homes and the Revenue & Benefits visiting officers

Sharon Brimson

Officers aware of key messages to parents, 2011/12. Highlighted at Revs & Bens stakeholder workshop April 2010

6.2 Ensure Enfield children have decent and secure homes

To be addressed as part of Enfield’s child poverty strategy

Enfield Homes

Child poverty strategy in place in 2011/12

6.3 Housing agencies to prioritise vulnerable families and expand provision of supported housing for

Consider access to mother and baby supported housing units within borough. Increase the support available to teenage parents within the 2 supported accommodation

Enfield Council Housing Department and safeguarding team.

Review of spaces available and support provided.

3 Overcrowded living conditions are associated with health problems such as stress and

depression, poor educational achievement of children and family breakdown. Although the

exact mechanisms are unknown, there appears to be a link between overcrowding and

Sudden Unexpected Death in Infancy (SUDI).

Policy objective



teenage parents

placements in Enfield (One Support Life House) to include parenting skills, provide support over night and allow fathers to stay where appropriate.

6.4 Improve cross disciplinary/ organisational working

RSL outreach staff are often first point of contact for families, ensure they have a pack of culturally sensitive information that could highlight issues of infant mortality & methods to reduce the risk

Sharon Brimson

Information packs to include messages on reducing the risk of cot death by end 2010/11

7. REDUCING CHILD POVERTY Eve Stickler

Policy objective



7.1

Reducing

child poverty

Undertake a child poverty

needs assessment to

inform the development of

a child poverty strategy

Deliver the child poverty

Family Intervention

Project

One Large Intervention project manager

Develop strategy and deliver FIP by end 2011

7.2

Increasing

parental

employment

in

sustainable

jobs:

Development of training programmes through 14-19 strategy for pregnant teenagers and teenage parents (see section 2.3 above)

Teenage Pregnancy partnership

KIS Training stats Connexions Care to Learn grant uptake (2010-11) All teenage parents known to services to have education or employment plans and access to accredited training programmes

Job brokerage staff to deliver sessions to parents after graduation from parent programmes.

Anne Stoker Increased uptake of employment for parents

Parent engagement panels (PEP) will have focus groups with Parent Champions within each CAP promoting raising aspirations, training and development, etc.

Anne Stoker Set up of PEP, identification of Parent Champions.

Roll out the Working Neighbourhoods Fund programme to support 50 workless families living in Enfield Island Village and explore rolling out to the Ladderswood estate.

Community & Campaigns Coordinator Community Access Childcare & Early Years

March 2011 for Enfield Island village – 35 parents supported into work, 15 parents to receive skills

Policy objective



(CACEY) & Sustainable Communities Team

development to help them back to work. Scheme established at Ladderswood

Set up a new Learn direct training centre in Edmonton Green library

Libraries Development and Operational Manager and CACEY

Established by Summer 2010. No. of parents taking part in activities at Learn Direct and No. of parents going on to employment as a result

7.3

Maximising

incomes

through

improving

the delivery

of benefits

and tax

credits

Increase financial capability amongst the most disadvantaged communities including support in accessing benefits such as working and family tax credits. Benefits sessions in primary schools and Children’s Centres

Children’s Centre Team, Welfare Benefits Advisor, Job Centre Plus, Schools

21.5% of parents taking up working tax credits

Ensure that staff in Children’s Centres and family support workers are equipped to provide information on an increased range of financial benefits that are available to low income families & ensure effective signposting to Job Centre Plus

Children’s Centre team

7.4

Reducing

educational

attainment

gaps for

children in

poverty

Increase opportunities in 14-19 vocational training, enterprise education, work related training, work based learning

Enfield Council

Increase in numbers of 14-19 in education, employment or training

Documents

APPENDIX 1 - Enfield Mortality... · Project quarterly report 2.3 Strengthen ... Enfield NHS Enfield A project lead has been ... (also approach Royal College to include in