Maternity and Early Years programme
Details of savings opportunity
The public health aspirations for healthy early years are that 0-5 year olds have:
- secure social and emotional attachment
- good cognitive development
- healthy eating habits
- good oral health
- good levels of social and physical activity and development
- protection from infectious disease
- good health outcomes through early identification of need and access to early help
- freedom from abuse or neglect
- parents or carers with life skills for health and wellbeing through critical early years life stages e.g. pregnancy, infanthood, weaning, bonding, transitioning to school age.
Developing the foundations for health and wellbeing in early years is a particularly high priority due to the strong evidence that good health in early years has a lifelong impact. The total investment in this area each year is £8.7m covering the following:
- Health Visiting - a workforce of specialist community public health nurses who provide expert advice, support and interventions to families with children in the first years of life (£6.8m)
- Health Visiting Growth Fund (£400k) – additional funding to increase numbers of Health Visitors
- Children`s Centres (£1m) – public health elements of Children`s Centres
- Family Nurse Partnership - a licensed service of specially trained family nurses who provide extra support to vulnerable, first time mothers aged 19 years and under (£550k)
- Breast Feeding Support a borough-wide breastfeeding support service that complements the Royal London Hospital maternity service (£328k)
- Unicef Baby Friendly – a programme to maintain UNICEF Baby Friendly accreditation in hospital and community settings (£143k)
- Locality Parent and Infant Wellbeing Coordinators – supports a team of peer supporters / volunteers to provide support for local parents and carers during pregnancy and the first year of the baby’s life (£160k)
- Healthy Start Vitamins - a programme to increase distribution and uptake of Healthy Start Vitamins for all pregnant women and children under 4 (£55k)
- Healthy Eating and Physical Activity – enables enable parents and carers to provide healthy food for their families and provides exploratory physical activity for their children (£54k)
- Healthy Early Years supports the accreditation of children`s centres as Healthy Early Years centres (£50k)
- Healthy Teeth in Schools – a fluoride varnish programme in schools to reduce tooth decay (£160k)
- Brushing for Life (£60k) – provides free toothbrushes and fluoride toothpaste for families with children in nurseries and children’s centres
Proposed budget reductions 16/17 and 17/18
- Health Visiting Growth Funding (£400k) - reduce by £69.6k (16/17) and a further £330.1k (17/18)
- Breast Feeding Support (£328k) - reduce by £32.8k (16/17)and a further £32.8k (17/18
- Unicef Baby Friendly (£143k) - reduce by £26.0k (16-17) and a further £2.4k (17/18)
- Healthy Start Vitamins (£55k) - reduce by £8.0k (16/17) and a further £8.0k (17/18)
- Brushing for Life(£60k) reduced by £40k from 16-17
From a base budget of £8,720,856 we are proposing a saving of £176,393 in 2016/17 and a full year saving of £549,657 in 2017/18.
The proposed savings are to a group of services commissioned by Public Health to ensure the health of expectant mothers and their infants is protected and improved in line with National Institute for Clinical Excellence (NICE) guidance. This highlights the importance of maternal and child nutrition and the positive impact of health and development reviews, health promotion, parenting support, screening and immunisation programmes upon the health of children and families as set out in the national Healthy Child Programme 0-5.
Health Visiting Growth Funding (£400k) - reduce by £69.6k and further £330,1k in 17/18
This is the funding allocated to increase the numbers of health visitors from its current baseline (£6.76m) towards target and in 16/17 most of it will be required to enable the smooth transition of the Health Visiting Team into the new service starting April 2016.
The implications of reducing the funding in 17/18 are that the Health Visitor workforce will not increase significantly above the current 83 qualified health visitors which have already been recruited. However, 83 qualified health visitors is a significant increase on the number that have been available in previous years and an improved service is anticipated from the new contract that started on 1 April 2016.
Breast Feeding Support (£328) - reduce by £32.8k in 16/17 and further £32.8k in 17/18
This service aims to increase the number of Tower Hamlets mothers who have a meaningful antenatal/postnatal contact with a member of the Tower Hamlets breastfeeding service or UNICEF Baby Friendly Coordinator at the Royal London Hospital or in community/home settings and to build the capacity of the breastfeeding volunteer peer support service. It is anticipated that staff numbers would reduce by approximately 2 whole time equivalent posts from the current 8 to 6 support workers.
The implications are that the number of mothers that can be supported with breast-feeding would be reduced by up to 660 in 2017-18 out of a total of 3,300 supported each year. Support will be targeted particularly on mothers in the most vulnerable groups in order to reduce the adverse health inequality impact.
UNICEF Baby Friendly (£143k) - reduce by £26.0k in 16/17 and further £2.4k in 17/18
The service supports UNICEF Baby Friendly Accreditation to ensure that hospital and community- based services such as primary care clinics provide an environment that actively supports and promotes breastfeeding. The proposed savings are to the training budget.
This service supports maternity services, health visitors and children`s centres to provide a baby friendly service that is accredited in line with the UNICEF standard and no significant impact is anticipated on the provision of this support.
Healthy Start Vitamins (£55k) reduce by £8k in 16/17 and further £8k in 17/18
The aim of the service is to improve the nutritional status and in particular prevent Vitamin D deficiency in pregnant women and children under 4 years. Provision of the service through community pharmacies has not worked as well as hoped and review indicates that it could be delivered at lower cost in house.
The implications are therefore minimal as transferring the service in house will maintain the numbers reached at lower cost.
Brushing for Life (60k) reduced by £40k in 2016-17
Brushing for Life is a programme aimed at preventing tooth decay in children under five. Brushing for Life provides tubes of fluoride toothpaste and a child's toothbrush in a pack which also contains educational material for the child, parents and carers. Our priority is to maintain the Healthy Teeth in Schools programme (fluoride varnish), which has been achieving increasing coverage of the cohort in Reception and Year 1 and has a stronger evidence base.
The reduction to the Brushing for Life programme can be absorbed without a major impact on the outcomes as it is intended to secure the supplies at lower cost and there are also other funding streams that children's centres can access to purchase the supplies in some cases, so a very limited overall impact is anticipated.
You can review the maternity and early years programme equalities screening.