New MBRRACE report published on maternal deaths and morbidity

The Institute joined colleagues from across perinatal services yesterday (Thursday 1 November) to learn lessons from the launch of the 2018 MBRRACE-UK report: Saving Lives, Improving Mothers’ care Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Death and Morbidity 2014-16.

We commend the report as essential reading for all health visitors and will be prioritising translating the learning into our various training programmes and publications, so that all health visitors and colleagues working with families in the perinatal period, understand the risks and know what to do about them.

Key Points:

A total of 225 women died among 2,301,628 women giving birth, giving a rate of 9.78 deaths per 100,000 women giving birth – which is almost the same as what is was in 2010-2012 (10 women per 100,000 maternities)
Heart disease remains the leading cause of women dying up to 6 weeks after the end of pregnancy
Maternal suicide is the 3rd largest cause of direct maternal deaths during pregnancy and up to 42 days of the end of pregnancy, but it is the leading cause of direct deaths occurring within a year after the end of pregnancy
There are striking inequalities that require urgent attention: Black women are 5 times more likely and Asian women twice as likely to die as white women
Most women who died had multiple health problems and or other vulnerabilities

Key messages:

Healthcare professionals need to challenge assumptions, for example, that symptoms are related to normal pregnancy or the woman has too many complex needs to be helped
Continuity of care is essential for trusting therapeutic relationships between women and their healthcare professional to develop
There needs to be more emphasis on training for non-specialists involved in the care of women in the perinatal period
Women who experience pregnancy or postnatal loss or have a child removed into care need ongoing support – indeed care should increase rather than decrease

Go to MBRRACE report, lay summary and infographic

iHV supports call for more investment into Early Intervention

iHV supports the call by the Early Intervention Foundation for more investment into Early Intervention in England, following the publication of its report, Realising the potential of early intervention. This report sets out a bold plan of action to ensure effective early intervention is available to the children, young people and families who need it most.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The Institute of Health Visiting supports the call by EIF for more investment into Early Intervention in England. We would like to see this extended to research and investment into whole universal systems change, as well as individually focused approaches. For example, health visitors are alarmed by seeing current cuts to their services resulting in many more vulnerable children having their needs recognised late, and needing much more complex and expensive interventions, than if their families had received sufficient early support that health visitors could once offer.”

Go to EIF Report - Realising the potential of early intervention

iHV welcomes Children’s Commissioner’s report into childhood vulnerability

The Children’s Commissioner for England, Anne Longfield, has published a new report that brings together a range of information held by various government departments, agencies and others to reveal the scale of child vulnerability in England.

The report, “The Children’s Commissioner’s 2018 Report into Childhood Vulnerability”, estimates that 2.1 million of England’s 11.8 million children – one in six – are living in families with risks so serious that they need some level of help. The study also warns that for 1.6 million of those vulnerable children, the support is effectively ‘invisible’ – we don’t know if they are actually getting any coordinated help, despite the difficulties they are growing up with. Some of the risks these children face include parents with mental health problems or parents who are alcoholics or have substance abuse problems.

Dr Cheryll Adams CBE, Executive Director of the Institute of Health Visiting, commented:

“The Institute of Health Visiting welcomes this very helpful report looking at the current status of services for our most vulnerable babies and children. It is very sad to see how the cuts to local authority children’s and public health funding have resulted in so many more children being put into expensive and life changing care proceedings.

“We welcome the Commissioner’s call for more investment into health visiting services for the most vulnerable babies, but this also needs to extend to the universal service for all families. We know that the majority of need isn’t conspicuous.

Dr Adams continued:

“Well trained and resourced health visiting services can not only prevent children ever needing referral to care services, but also ensure that all vulnerable babies are identified long before their difficulties become overt and needing referral for specialist help. Through their support to parents, health visitors can help to ensure all children have a more positive start in life with the service seeking to avoid children ever needing care proceedings.

“Investing early to save later needs to be a new direction for policy. It could have huge implications for the health and welfare of many vulnerable or potentially vulnerable children and families, whilst resulting in many savings to the exchequer.”

Read The Children’s Commissioner’s 2018 Report into Childhood Vulnerability

Read the full news story from the Children's Commissioner

Professional bodies and maternal mental health experts welcome report highlighting need for more maternal mental health experts

The Maternal Mental Health Alliance (MMHA), the Institute of Health Visiting (iHV), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Royal College of Midwives (RCM) are delighted the NHS Benchmarking report on Universal Perinatal Mental Health Findings was published on Friday 14 September.

Prior to this study, information on service provision and staffing of universal perinatal mental health (PMH) services was not available at a national level. The study sought to gain an understanding of the extent of PMH provision in universal services across England, supplementing an annual audit of Specialist PMH services undertaken by the NHS Benchmarking Network for NHS England.

The data collected from providers suggested that:

Capacity in universal services is very limited and does not provide the necessary broad base from which the Specialist PMH services can operate effectively and efficiently as a secondary care tier.
The provision of specialist perinatal mental health care within universal services is highly variable across England, with some areas having no, or limited, provision (obstetric & midwifery providers 61%; health visiting providers 30%).

Specialist provision within universal services is necessary to coordinate, inform and support evidence based PMH care across the whole service, and therefore offers a clear reflection of the care women are able to access. The large gap in health visiting PMH capacity was particularly evident, with 70% of providers having no specialist provision within the service.

If we are to deliver on the ambition of the Five Year Forward View for Mental Health, attention must be paid to the full spectrum of need. This report is critical because it focuses on the universal element, where the vast majority of women need to receive their care. Most recognition of mental health problems and risks, most prevention and early intervention, can only be coordinated and provided within universal services. Universal services are therefore a crucial element of the PMH care pathway at every local level and have the potential to create great savings in relation to both human and economic costs in the short and long term.

Dr Cheryll Adams, Executive Director at the iHV, said:

“The Institute of Health Visiting warns that the real state of today’s health visiting support for mothers suffering with perinatal mental illness (PMI) may be significantly worse than that found by the NHS Benchmarking report based on data from 2016, as there have been further cuts to the workforce and the development of a significant postcode lottery of services up and down the country. Health visitors across the country nevertheless continue to strive to deliver an excellent service to children and families, and will do everything in their power to promote good family mental health.”

Alain Gregoire, Chair of the MMHA, said:

“There has been excellent progress in funding specialist perinatal service provision across England, but we know that specialist services alone are not enough. All women in pregnancy and postnatally should have equitable access to the support, prevention and treatment they need for their mental health as much as for their physical health. This report shows that investment is essential to ensure that there are sufficient, well-trained staff across universal services so that women get the care they should expect from the NHS, and our children can get the best start in life.”

Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said:

“Whilst there is progress in some areas, there is still a lot more to do. Our survey showed that we remain seriously short of specialist maternal mental health midwives and services to support women with mental health problems and needs in the community and in their homes. There is also a need to ensure that all midwives involved in the care of pregnant women receive adequate training, so that they can identify women with mental health problems and refer them appropriately for care and support as required.”

Dr Alison Wright, Consultant Obstetrician and Vice President of the Royal College of Obstetricians and Gynaecologists said:

“Despite maternal mental health being a key priority of the Government, this report shows the extreme pressure faced by obstetricians and psychiatrists, midwives and health visitors who provide perinatal mental healthcare. Healthcare professionals are usually the first point of contact that a woman reaches out to and we must ensure that all staff involved in the care of women during pregnancy and beyond, have the relevant education and training in perinatal mental health. Every maternity unit across the country should have in place a clearly defined care pathway for referring women to local specialised perinatal mental health services which all women can access when needed.”

Collectively, we will continue to push for equitable access to evidence based PMH care for women with mental health problems and their families through robust universal services alongside the development of specialist PMH services – women and their families need both. We support the call for all maternity and health visiting services (and GP services) to be sufficiently resourced, so that all professionals across universal services have sufficient capacity, competence and confidence to deliver top quality proactive mental health care to all families. Furthermore, we advocate that these healthcare professionals should be supported by having lead specialist professionals/Champions from within their respective professions in every organisation.

Download the NHS Benchmarking report on Universal Perinatal Mental Health Findings

Background Information to the report

In January 2017, the NHS Benchmarking Network was commissioned by Health Education England, funded by NHS England, and partnered with the iHV, RCOG and RCM to complete a stocktake of perinatal mental health (PMH) care within maternity and health visiting services. Data collection took place from February to May 2017 and referenced the year January to December 2016. Universal PMH services in this report included obstetrics, midwifery and health visiting.

There was a high response rate from organisations across England, with numbers of responses by service type as follows:

Obstetric services 141
Midwifery services 123
Health visiting services 88

In total, the following specialist practitioners were identified in the study:

Obstetric services = 40.8 WTE (1.3% of total obstetric capacity)
Midwifery services = 228 WTE (1.4% of total midwifery capacity)
Health Visiting services = 60.6 WTE (0.78% of total health visiting capacity)

Child health in England falling behind other European countries

A new report, published today by The Royal College of Paediatrics and Child Health (RCPCH) ,warns that child health in England is lagging behind other European countries, with child mortality potentially 140% higher than other comparable nations by 2030 and reported mental health problems set to increase by 60%.

The ‘Child health in 2030 in England: comparisons with other wealthy countries’ report compares England with European and other western countries known as the EU15+. With the combination of England’s current poor standing for key outcomes in line with the averages in the EU15+, and our slower rates of improvement for key outcomes, the report finds that child health outcomes in England will not only compare very poorly to similar countries in 2030, but that we will be falling even further behind. The marked health inequalities between the most and least deprived children in most key outcomes are also set to widen over the next decade – presenting real challenges for health services in ensuring and improving access to those who need them most.

Dr Cheryll Adams CBE, Executive Director at the Institute of Health Visiting said:

“It feels very timely for the RCPCH to produce this report – ‘State of Child Health 2030’ to alert MPs and policy makers to the risks of not taking action now to strengthen all services for children. Health visitors are already very concerned by the impact of current issues for children such as increasing childhood poverty, mental illness and obesity set against a decommissioning of essential services such as health visiting and school nursing due to recent reductions in public health budgets.

“These challenges faced by children and families are not just worrying for their impact on the life course of those affected. We also now have good evidence that they will also be having significant impacts on the economy now and in the future. We recommend ministers heed the advice of Nobel prize winner James Heckman and invest into the very early years to reduce later fiscal expenditure. We believe that the benefits to the economy would quickly be felt by government.”

Amongst the report’s key findings are:

Mortality rates may be 140% higher for infants in England than in comparable wealthy nations by 2030
Reported mental health problems are set to increase by 60%, based on current trends
1 in 3 of the most deprived boys in England will be obese by 2030 without urgent implementation of the Childhood Obesity Plan and additional measures
A&E attendances for children may increase by 50% and outpatient attendances by 48%

In response, RCPCH is urging NHS England to develop and implement a Children and Young People’s Health Strategy as part of its long-term plan. They believe that a holistic CYP Health Strategy is essential to drive forward the ambitious actions, coordination and leadership needed to address the complex factors underpinning their findings. The long-term plan offers a critical opportunity to put children and young people at the heart of our health service, at every level, and the report demonstrates the risks of not taking action as soon as possible.

Download RCPCH State of Child Health short report: Child health in 2030 in England: comparisons with other wealthy countries

Download State of Child Health short report: Child health in 2030 in England - Recommendations

iHV publishes report from well-regarded breastfeeding conference

During #WorldBreastfeedingWeek, the iHV is delighted to publish a report from its well-regarded breastfeeding conference held in April with the World Breastfeeding Trends Initiative (WBTi) and Royal Society for Public Health (RSPH).

The Breastfeeding: A Public Health Priority report gives a conference summary and implications for Public Health.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“This highly successful breastfeeding conference included, as speakers, some of the leading researchers in the field, as well as a range of successful local initiatives. We are delighted to be sharing a report from the day.”

Dr Cheryll Adams opening the breastfeeding conference

Go to members only Breastfeeding resources to download Breastfeeding conference report

Please note that these resources are available to iHV members only – if you’re not a member, please join us to get access to all of our resources.

The iHV is a self-funding charity – we can only be successful in our mission to strengthen health visiting practice if the health visiting profession and its supporters join us on our journey. We rely on our membership to develop new resources for our members.

Read the news story from the breastfeeding conference

iHV welcomes Mental Health Policy Commission: Investing in a Resilient Generation report

The root causes of mental health problems can often be traced to adversity in childhood or adolescence, but the effects can have a life-long impact on well-being and the ability to live a satisfying and productive life throughout adulthood.

iHV welcomes Mental Health Policy Commission: Investing in a Resilient Generation report which sets out the evidence base around the factors that can impact on young people’s mental health.

Dr Cheryll Adams CBE, Executive Director iHV commented:

“This is a very timely and helpful piece of work emphasising the huge benefits to NHS spending from investing in prevention of mental illness in the very early years, and in schools. We really hope that local authorities will take note of its recommendations and reconsider any more cuts planned to health visitor services. Savings can be made in different ways and this document makes clear that cutting preventative services creates a significant burden of expenditure that must be picked up later by public services.

“It is time to be brave and invest for tomorrow, not today, giving more children a bright future by supporting them as babies and infants when supportive interventions for families have the most powerful impact on their mental wellbeing. The toll of mental illness is now so significant and conspicuous that there is a civil and moral duty for all those with influence to reduce this by supporting investment into early preventative strategies as laid out in the recommendations of this report.”

Go to Mental Health Policy Commission: Investing in a Resilient Generation report

iHV welcomes Childhood obesity: a plan for action, chapter 2

Part 2 of the government’s plan for action to significantly reduce childhood obesity by supporting healthier choices was published this week.

This publication outlines the actions the government will take towards its goal of halving childhood obesity and reducing the gap in obesity between children from the most and least deprived areas by 2030. Building on the first chapter of the childhood obesity plan, the new measures include proposals to counter ‘pester power’ by preventing stores from displaying unhealthy food at checkouts or including it in buy-one-get-one-free deals.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The Institute of Health Visiting welcomes the tightening of the update plan for Childhood Obesity. It is crucial that the preventative measures outlined are actioned with speed to ensure that all children in the UK are able to thrive and develop to their full potential.

“Tackling the wider factors that impact on obesity is crucial and we applaud the move to target advertising. The need to work across all sectors who provide “food away from home” is crucial and proposals to work with schools are well placed, we trust that these actions will also include early years providers – both state and private nursery provision, as the early years are crucial in the development of healthy weight in the later years.

“Whilst it is not explicitly stated there is a need to ensure that the revised actions have a focus on the early years (0-5 years) as we know from research that the influence of early nutrition and eating patterns is directly correlated with obesity in later years. To support this it will be crucial to consider the early year’s health and social care work force in the development of training proposed in this update.”

The government is calling on industry to recognise the harm that adverts for foods high in fat, sugar and salt can cause. It will consult on introducing new TV and online advertising restrictions to prevent children from being targeted by these unhealthy products, and to incentivise companies to reduce the sugar and calories in the products they sell.

The second chapter of the plan also promotes a new national ambition for every primary school to adopt a daily ‘active mile’ initiative, such as the Daily Mile.

Go to DHSC Guidance - Childhood obesity: a plan for action, chapter 2

Who’s the bloke in the room? report

“Who’s the bloke in the room?” a report published by the Fatherhood Institute and funded by the Nuffield Foundation, details how expectant fathers in Britain are key influences on maternal and infant health and wellbeing, including on pregnant women’s smoking, diet, physical activity and mental health, and on children’s later adjustment.

The Fatherhood Institute’s report, Who’s the bloke in the room? recommends a more family-centred service that enrols expectant fathers in maternity services from ‘booking in’, records and responds to their health needs and behaviours, and which trains maternity staff to engage with them. The Fatherhood Institute calls on the NHS to include expectant and new fathers at all stages and inform them as thoroughly as it currently informs pregnant women and new mothers.

You can access the full Who’s the bloke in the room? report (and others in the series) here

iHV welcomes Bercow: Ten years on report

iHV welcomes the Bercow: Ten years on report and its recommendations, published by I CAN (the children’s communication charity) and The Royal College of Speech and Language Therapists (RCSLT) on 20 March 2018.

In particular, the iHV welcomes the recommendation that Public Health England should support the development of national health visitor training on identifying and supporting SLCN.

Bercow: Ten years on reports on the state of provision for children’s speech, language and communication needs (SLCN) in England. It lays bare the current picture of services for young people with SLCN and makes informed recommendations of what must be done to improve the situation at a local and national level.

Through extensive evidence gathering, I CAN and the RCSLT collected the views of children and young people, parents and carers, speech and language therapists, education professionals, commissioners and many others about the reality of support for children and young people with speech, language and communication needs in 2018. This included information from the iHV’s State of Health Visiting Survey 2017 which found that 74% of health visitors have seen a rise in the number of children with SLCN.

The report shows poor understanding of and insufficient resourcing for speech, language and communication needs. This means too many children and young people receive inadequate, ineffective and inequitable support, potentially impacting on their educational outcomes, their employability and their mental health.

Follow #Bercow10 on Twitter

Download 2-page Summary report - Bercow:Ten years on

Download Full Report - Bercow: Ten years on