Hull Public Health 

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Joint Strategic Needs Assessment 2018


Best Start in Life (Children and Young People)

The “Hull – Healthier Together” Health and Wellbeing Strategy 2014-2020 [1] are covered in three broad outcomes:

1. The best start in life;
2. Healthier, longer, happy lives; and
3. Safe and independent lives.

“What happens in early years has a lifelong impact. Giving every child the best start is crucial to reducing health inequalities across the life course. Healthy and informed parents who have control over their own wellbeing will have healthier babies and raise healthier children.

Children who are ready for school will be able to get the most out of their education and fulfil their potential. Building emotional resilience will help children handle the pressures of growing up and give them the right knowledge and skills to overcome challenges.

Families who make healthy lifestyle choices will thrive” [1].

This section includes topics which generally relate to maternal health, children and young people, although there is information relating to children and young people in other sections, such as population, ethnicity and population projections, health, wellbeing and use of health services including dental services, behavioural and lifestyle risk factors, new-born screening checks is covered in the screening topic, some diseases relevant to children such as asthma, diabetes and epilepsy are covered in the adult section as this covers most of the disease and medical condition topics, sexual health is covered in the adult section although teenage pregnancy is covered within this section on children and young people, and learning disabilities is covered within the vulnerable group section.

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Maternity

Also see the sections on Breastfeeding and Best Start in Life and Transition into Adulthood.

What’s the issue?

“Maternity services cover care for the women from when they become pregnant and access care until they are signed off by the midwife (around 10 days after the birth) and care formally handed over to health visitors” [175]. Good antenatal care and support can identify potential problems early, and provide information to aid informed choice. Poor care during the birth can increase the risks to both mother and baby. “Good maternity services should respond to the physical, psychological, emotional and social needs of women and their family in a structured and systematic way” [175].

Women who lack social support have been found to be at increased risk of antenatal and postnatal depression, and having a poor relationship with a partner is also a risk factor for postnatal depression [176]. Infant mortality rates are higher among babies that are sole registered than for other registration types [177].

There is a higher risk of adverse events in pregnancy and during the birth for women who are teenagers, who are older, who smoke, who are overweight and who have other risk factors such as diabetes. The proportion of births to older women and women who are overweight has increased giving rise to an increase in the likelihood of adverse events. This, together with the higher number of births overall, has placed additional pressure on already stretched maternity services nationally.

There are a number of screening programmes in place in the UK relating to antenatal and newborn. "Tests in pregnancy and in the newborn after birth are designed to help make the pregnancy safer, check and assess the development and wellbeing of the women and her baby, and screen for particular conditions" [178, 179, 180]. Further information is given in the Screening section.

What’s our situation?

Whilst the rate of under 18 conceptions (see here) and smoking in pregnancy (see here) has decreased in Hull, it is still higher than the national average, and there are increasing numbers of older women having children and women who are overweight. Thus there is an increasing number of women giving birth who have a higher risk of an adverse event.

During the three year period 2013-15, there were 74 stillbirths in Hull giving a rate of 6.8 per 1,000 births which was higher than England (4.6) and whilst it had been higher in 2012-14 (5.8 v 4.7) it had been lower in Hull in 2011-13 (4.7 v 4.9) and 2012-14 (4.3 v 5.1) [27, 99, 103, 104, 181]. During 2014-16, there were 40 infant deaths (<1 year) giving a rate of 3.9 per 1,000 live births in Hull which was similar to England (3.8) [27, 99, 103, 104, 181]. During the financial year 2016/17, at the time of their initial antenatal (booking) appointment, 1,153 (28%) were overweight (body mass index (BMI) 25-29.9kg/m²), 617 (15%) had a BMI 30-34.9kg/m², 313 (8%) had a BMI 35-39.9kg/m² (see JSNA Glossary for a definition of BMI) and 184 (4.5%) had a BMI 40+kg/m² (so 2,267 women out of 4,063 (56%) were overweight which included 27% who were obese and 4.5% who were morbidly obese) [182]. In 2016/17, 878 out of 3,834 women (22.9%) were known to be smokers at the time of delivery, compared with 10.5% for England [27, 117, 139]. Whilst the rate in Hull has fallen since 2005/06 when it was 29.6%, it has increased from 2014/15 when it was 20.9% due to the introduction of carbon monoxide (CO) testing at antenatal booking appointment (and at subsequent antenatal appointments if positive). The rate in Hull is currently second highest among the 209 CCGs. Over one quarter of babies (26.1%) were born in Hull by caesarean section in 2015/16 (similar to England 26.1%) [181]. A lower percentage of births were multiple births in Hull (13.8%) compared to England (16.0%) in 2015, which could be associated with the lower percentage of births to mothers aged 35+ years in 2015/16 (11.0% versus 21.1%) [181]. Overall, 109 out of 3,306 babies (3.3%) were born to term (37+ weeks) and were of low birth weight (<2.5kg) in Hull for 2015 which was higher than England (2.8%) although it has been lower than England for five of the six previous years [27, 152, 181]. In 2013/14, it is estimated (using national prevalence data), that 10 women will have postpartum psychosis, 10 chronic serious mental illness, 105 severe depressive illness, between 345 and 515 mild or moderate depressive illness or anxiety, 30 post traumatic stress disorder, and between 150 and 300 adjustment disorders and distress [183].

What are the strategic needs?

The Better Births national maternity view states that “every women, every pregnancy, every baby and every family is different. Therefore, quality services (by which we mean safe, clinically effective and providing a good experience) must be personalised” [184]. The vision for maternity services across England is “for them to become safer, more personalised, kinder, professional and more family friendly; where every woman has access to information to enable her to make decisions about her care; and where she and her baby can access support that is centred around their individual needs and circumstances. And for all staff to be supported to deliver care which is women centred, working in high performing teams, in organisations which are well led and in cultures that promote innovation, continuous learning, and break down organisational and professional boundaries” [184]. The national Maternity Transformation Programme [185] seeks to achieve the vision set out in Better Births vision working across nine work streams: (1) transforming the workforce; (2) sharing data and information; (3) harnessing digital technology; (4) reforming the payment system; (5) promoting good practice for safer care; (6) improving prevention; (7) improving access to perinatal mental health services; (8) supporting local transformation; (9) increasing choice and personalisation.

Hull's Maternity Commissioning Strategy published in 2015 [186] has five key outcomes: an improvement in maternal health (including early access to midwifery, maternal obesity and smoking); reductions in maternal and stillbirths/infant mortality, and infant morbidity; and an improvement in maternity services experience. Improving mental health is also an important area of work. Hull's new Maternity Commissioning Strategy is due to be finalised in 2018.

The Humber, Coast and Vale Sustainability and Transformation Partnership (STP) [3] Local Maternity System aims to put individual quality and safety at the core of service delivery and delivery improvements in perinatal mental health prioritising on improving choice, personalisation and continuity of care.

Work needs to continue to reduce the under 18 conception rate (see here), as well as reduce the number of women who are obese or who smoke (see here), with a need to provide help and advice prior to pregnancy to attempt to reduce these risks (although recognising that not all pregnancies are planned). Identifying risks and intervening early to improve maternal health and wellbeing, improving birth preparation, promoting positive parenting skills, and creating an environment for children and young people that builds self-esteem and resilience, with good emotional health. Early help and intervention for all families should be timely, accessible and appropriate for their circumstances. Hull's Early Help and Priorities Family Strategy 2015-2020 (see the JSNA Glossary) aims to identify individuals and families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in an coordinated way [119]. The framework outlines the approach to ensure that collaboration and alignment of services, and that early help may be 'early in life or at the earliest opportunity' which is also part of the day job, helpful, non-stigmatising, preventative, targeted and tailored [119]. There are four thresholds of need: (i) no additional needs which is the universal response to build resilience in children and young people; (ii) additional needs involving prevention and early help; (iii) complex needs involving a targeted response of early help and interventions; and (iv) risk of significant harm which includes child protection procedures and safeguarding services.

This 2018 JSNA section on Maternity (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Children and Young People (171 pages))
JSNA Toolkit: Demography and Demographics (223 pages)

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Breastfeeding

What’s the issue?

“It is recommended that babies are fed exclusively with breast milk for the first six months of their life, and after that giving a baby breast milk alongside family foods for as long as the mother and baby want. Breast milk is perfectly designed for a baby, and adapts as the baby grows to meet the baby's changing needs. Breastfeeding can build a strong emotional bond between mother and baby, and milk is available whenever a baby needs it. Breastfeeding has additional health benefits for the baby reducing both infections, and diarrhoea and vomiting (resulting in fewer hospital visits), sudden infant death syndrome, childhood leukaemia, type 2 diabetes, obesity and cardiovascular disease in adulthood. Breastfeeding and making breast milk also has health benefits for the mother and reduces the risk of breast cancer, ovarian cancer, osteoporosis, cardiovascular disease and obesity” [187]. Breastfeeding also is considerably cheaper as it avoids the need to buy infant formula milk.

Nationally, if all babies were breastfed, it is estimated that £35 million each year could be saved by the NHS due to treating gastroenteritis alone. Even if breastfeeding prevalence at 6 months was increased by 10%, it is estimated that the NHS could save at least £5.6 million over 4-5 years due to the prevention of cases of otitis media, gastroenteritis and asthma. The cost savings in Hull from these three conditions is estimated to be £33,945 per year (although not all savings will be realised in the first year) [188].

What’s our situation?

For 2014/15, the breastfeeding initiation rate in Hull was 61.5% having increased since 2010/11 (57.2%), but remains significantly lower than England (74.3%) and slightly lower than the average of the 10 comparators (64.5%) [27, 181]. The prevalence of (partially or totally) breastfeeding at 6-8 weeks for 2016/17 was 30.1% which was considerably lower than England (44.4%). The percentage had been increasing in Hull, but due to differences in data collection methods the current rate cannot be compared with historical data [27, 181, 189]. Local analysis of breastfeeding rates at 6-8 weeks revealed the strong influence of deprivation and ethnicity [152].

Full UNICEF accreditation for the community was achieved in 2013 (and more recently renewed in December 2015) which involved training all children's centre staff, Health Visitors and a range of local authority teams. A re-assessment will be completed in 2018. Part of the accreditation is to engage local businesses to promote breastfeeding in premises locally. Work is ongoing to increase the confidence of Hull mothers to breastfeed in a culture which is predominantly to formula feed. Hull and East Yorkshire Women and Children's Hospital achieved full accreditation last year and will be re-accredited next year [190].

Doulas and peer supporters are commissioned to support women to breastfeed.

What are the strategic needs?

Encourage as many women to breastfeed their babies as possible by explaining the advantages, and by offering advice and support, both prenatally and post-natal. This involves providing quality information, implementing a structured programme of activity using the UNICEF Baby Friendly Initiative as a minimum, training healthcare and support staff to be confident and competent to support breastfeeding mothers, and supporting all mothers and increasing their confidence to breastfeed [188]. Birth preparation and parent education services provide antenatal education and supports improving breastfeeding rates. Locally, there are discussions occurring with the aim of including breastfeeding in Personal, Social and Health Education classes in schools, and in other health and social care courses.

As the largest decrease in breastfeeding occurs within the first ten days and the first Health Visitor contact is at 14 days, local Health Visitors are working to promote the peer supporter service locally to help mothers to continue to breastfeed prior to the first Health Visitor appointment. There is an expectation that health visitors will visit before the ten days to try to help young mothers to continue breastfeeding at a time when they might be thinking about stopping.

This 2018 JSNA section on Breastfeeding (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Children and Young People (171 pages)

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Best Start in Life and Transition into Adulthood

What’s the issue?

Every child deserves the best possible start in life and the support that enables them to fulfil their potential. Children develop quickly in the early years and a child's experiences between birth and age five have a major impact on their future life chances. A secure and happy childhood is important in its own right. Good parenting and high quality early learning together provide the foundation children need to make the most of their abilities and talents as they grow up.

Marmot in his strategic review of health inequalities in England post-2010 [191] stated that “Parents are the most important ‘educators’ of their children for both cognitive and non-cognitive skills. Parental involvement in their child's reading has been found to be the most important determinant of language and emergent literacy [192]. Recent analysis of data from the Millennium Cohort Study suggests that parents who combine high levels of parental warmth with high levels of supervision are more likely to have children at age five who are more confident, autonomous and empathic. On the other hand, a 'disengaged' parenting style is associated with poorer outcomes for children” [193] “in terms of qualifications, relationship problems, unemployment and becoming teenage parents” [111].

As well as good home learning environment, early years education is very important. “The original Sure Start Children's Centres programme was based on evidence that effective early intervention prevented costs to society later on [194, 195]. Locally-led community-based programmes can engage those families who might not otherwise seek help [196]” [197]. “Pre-school shows a significant positive effect on early cognitive outcomes for all levels of quality and duration compared to none. Overall having long pre-school experience has greater benefit on literacy outcomes, whatever the quality, although long good quality pre-school had the greatest effects on early outcomes and at age 11 (test scores and social and behavioural outcomes)” [197].

Ensuring children are ready for school and can achieve good levels of education is essential for them to achieve well-paid satisfying regular employment, increase resilience, and improve health and wellbeing (see the section on Schools and Educatoinal Attainment). Children living in more deprived areas are more likely to grow up thinking that poverty, poor housing, and unemployment are the norm, which could result in cyclic behaviours with these children behaving as their parents do as they reach adulthood. “Early intervention in childhood can help reduce physical and mental health problems and prevent social dysfunction being passed from one generation to the next” [111] (also see the section on Emotional Health and Wellbeing).

Following the Children and Families Act 2014, children and young people (under the age of 25 years) who have special educational needs may have an Education, Health and Care (EHC) plan, developed by all professionals and the family working together, to address all needs that a child or young person has within education, health and care (see the section on Learning Disabilities).

The transition between education and employment can be difficult for many young people, but especially so for young people who lack good working role models, have poor literacy and/or numeracy skills, do not feel confident about themselves and lack resilience to cope with changing circumstances. It is even more difficult for vulnerable groups such as those with learning disabilities or young people who have been in care and/or young people who do not have family support networks. Young people with poor educational attainment are more likely to be not in education, employment or training (NEET) and more likely to become teenage parents. The teenage years are generally the time when young people experiment with unhealthy lifestyle behaviours such as smoking, alcohol consumption and using drugs, and this behaviour is more likely to be tried or sustained among vulnerable young people and those finding the transition into adulthood difficult.

There may be a change in services available to young people who are ill or have long-term medical conditions and diseases such as diabetes, learning disabilities or mental health. Continuity of care is important in order to facilitate a smooth transition into adulthood.

What’s our situation?

Due to the increased levels of deprivation in Hull, the majority of children are at an increased risk of not fulfilling their potential and having worse health than England as a whole. A higher percentage of children in Hull live in poverty (see the sectoin on Deprivation and Poverty) and many children have an immediate disadvantage in life due to their circumstances. Compared to England, there is a higher rate of emergency admission for accidents (see the section on Accidents to Children and Young People), and fewer children in Hull are ready for school and achieve good or strong GCSEs passes and there are more children with special educational needs (see here). Compared to England, babies are less likely to be breastfed (see here) and children more likely to have unhealthy lifestyle behaviours (see here) such as poor diets and low levels of physical activity. Children living in the most deprived areas are also more likely to be exposed to second-hand smoke (see the section on Smoking) and become smokers themselves [198, 199]. Children and young people living in the most deprived areas are more likely to have learning disabilities, poorer physical health, poorer emotional health and poorer oral health. The percentage of pupils requiring special educational needs (SEN) support or Education, Health and Care (EHC) plans is higher than England (see here). Whilst under 18 conception rates have fallen greatly in Hull over the last decade, they are much higher than England (see here). The percentage of people in Hull aged 16-18 years who were NEET was just over 10% in 2011 (November 2011 to January 2012) and 2012, and has almost halved to 5.7% in both 2013 and 2014 and had slightly risen to 6.2% for 2015 (England 4.2%) [27]. There were 570 16-18 year old NEETs in Hull in 2015.

Across England, in October 2015, the responsibility for commissioning public health services for children aged 0-19 years moved from the NHS to the local authority.

What are the strategic needs?

Hull has had significant investment as part of the National Health Visitor implementation plan with additional health visitors all of whom will be focusing on the first 1001 days and the six high impact areas of health: (i) transition to parenthood and the early weeks; (ii) maternal (perinatal) mental health; (iii) breastfeeding; (iv) healthy weight (healthy diet and being active); (v) managing minor illness and reducing accidents; and (vi) health, wellbeing and development at two years and support to be 'ready for school'. The aim of the First 1001 Days The All Party Parliamentary Group [200] is to create children who at the end of their first 1001 days (conception to age 2 years) have the social and emotional resources that form a strong foundation for good citizenship. They state that without intervention, there will be in the future, as in the past, high intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment. These self-perpetuating cycles create untold and recurring costs for society. The economic value of breaking these cycles will be enormous. The Priority Families programme in Hull (the city's response to the national Troubled Families initiative) aims to change these repeating generational patterns of poor parenting, abuse, violence, drug use, anti-social behaviour and crime in the most troubled families in Hull (see the JSNA Glossary). This programme is including in Hull's Early Help and Priorities Family Strategy 2015-2020 [119] (see the JSNA Glossary) aims to identify individuals and families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in an coordinated way. The framework outlines the approach to ensure that collaboration and alignment of services, and that early help may be ‘early in life or at the earliest opportunity’ which is also part of the day job, helpful, non-stigmatising, preventative, targeted and tailored. There are four thresholds of need: (i) no additional needs which is the universal response to build resilience in children and young people; (ii) additional needs involving prevention and early help; (iii) complex needs involving a targeted response of early help and interventions; and (iv) risk of significant harm which includes child protection procedures and safeguarding services.

The Two Year Old Early Education Entitlement for eligible children and families is activity promoted and ways to increase uptake is constantly under review. Work with health visitors is being used to pilot best practice in the implementation of the Integrated Two Year review and to support eligible families to access their early education entitlement. Staff training and qualifications and the manager's qualifications are key to good quality early years education [197] so the aim should be to improve staff training and qualifications to maximise outcomes within early years and beyond. Further information relating to schools and educational attainment is given in the section on Schools and Educational Attainment.

Transition protocols are being developed in Hull to help with the transition between education and employment which can be particularly difficult for young people from vulnerable groups. Successful coordinated approaches have been used in Hull in relation to changing repeating generational patterns of poor parenting, abuse, violence, drug use, anti-social behaviour and crime in Hull's Priority Families (see the JSNA Glossary), reducing the under 18 conception rate and reducing the percentage of NEETs, and these need to be continued in order to maintain the momentum.

This 2018 JSNA section on Best Start in Life and Transition into Adulthood (4 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Children and Young People (171 pages)

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Accidents to Children and Young People

What’s the issue?

“More than one million children under the age of 15 experience accidents in and around the home every year in the UK, for which they are taken to A&E. Many more are treated by GPs, parents and carers” [201]. “In the UK, accidental injuries are the most common cause of death in children over one year of age. Children under five are most at risk from an injury in the home, with boys more likely to be injured than girls. Burns and scalds, swallowing of foreign objects and suspected poisoning are common in younger children whereas older children are more likely to experience fractures. Many accidents and deaths that occur in the home are avoidable. Young children are unable to assess the risks that things pose, and are particularly at risk if distracted, under poor supervision, being in a hurry or unfamiliar with surroundings. Their perception of the environment around them is often limited and their lack of experience and development, such as poor coordination and balance, can result in them being injured. Poor housing and overcrowded conditions also increase risk, with childhood accidents closely linked to social deprivation” [202].

What’s our situation?

In 2015/16 the hospital admission rate due to unintentional and deliberate injuries in children aged 0-14 years in Hull was 134 per 100,000 (a total of 637 admissions) and 151 per 100,000 (271 admissions) among those aged 0-4 years [27, 117, 203]. Both rates have increased over time, and are currently higher than England (104 and 130 respectively). The national inequalities gap has also widened over time, and there is a much higher admission rate among the most deprived fifth compared to least deprived fifth of Hull (35% higher for 0-14s and 23% higher for 0-4s) with huge differences across the wards (admissions of 66 in Avenue and 155 in Newland per 100,000 population for 0-14s).

For 2015/16, among those aged 15-24 years, there were 555 admissions giving an admission rate of 145 per 100,000 population which was 8% higher than England [27, 117, 203]. Rates were over 200 admissions per 100,000 population 15 years ago, so have decreased over time. Nevertheless, there are huge local inequalities (220 versus 107 admissions per 100,000 population for most and least deprived fifths in Hull) and across the wards (admissions of 63 and 279 per 100,000 population in Boothferry and St Andrew's wards respectively).

There is growing anecdotal evidence that more children are being injured as passengers in cars in Hull, which is a trend mirroring the national trend. This is perhaps not surprising, given that car seat safety checks undertaken in Hull consistently show that around 80% of child seats are fitted incorrectly. See also the section on road traffic accidents.

What are the strategic needs?

Parents and carers of young children should be aware of the dangers to young children in the home and whilst travelling, and should be given help and support to reduce these dangers. These risks and dangers are generally discussed during pregnancy and post-natal care, and Children’s Centres do a great deal to raise this awareness, including undertaking home visits and risk assessments. The Focus on Safety Award is an initiative with Public Health, Health and Safety and local nurseries to raise awareness and give key messages to parents and children whilst encouraging nurseries to work beyond the minimum requirement of the legislation. Road Safety services attend the monthly Hull and East Yorkshire Hospital NHS Trust (HEYHT) ‘Hey Baby Carousel’ that are part of the Birth Preparation and Parent Education Service and provide information about car seat safety for babies and young children to new parents. Kid Alert is an annual initiative involving around 2,000 Year 6 (aged 10-11 years) children who go through a series of scenarios looking at different areas of safety. There is a Hull and East Riding Safe Sleeping Group which promotes safe sleeping habits for babies. There is also a Strategic Accident Prevention Task and Finish Group, and other regular promotion events in relation to home safety such as the National Play Day event and the Christmas Child Safety Campaign.

This 2018 JSNA section on Accidents to Children and Young People (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Accidents (91 pages)

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Vaccinations and Immunisations

What’s the issue?

Specific vaccines are offered to children, young people, pregnant women, older people and other adults with specific long-term health conditions. All children are offered vaccines against key diseases to prevent them getting serious diseases that can kill or cause long-term health consequences. A small number of vaccines are just offered to a selected group of children and adults who are at risk owing to their personal circumstances. Older people and other at risk groups are offered the seasonal influenza vaccination to reduce the likelihood of influenza. There is also a vaccine for shingles offered to specific older age groups. NHS Choices provides a full list of vaccines routinely offered [204].

What’s our situation?

From the Public Health Outcomes Framework dataset [27], during 2015/16, 43% and 30% of eligible one and two year olds received their Hepatitis B vaccination (although numbers are small with only around 20 children eligible each year). Among all one year olds, 96% had received their diphtheria, tetanus and pertussis (DTP) / inactivated polio vaccine (IPV) / haemophilus influenza type b (Hib) vaccinations, 98% had had their meningococcal C (MenC) vaccination and 96% had received the pneumococcal conjugate vaccine (PCV). Immunisation rates among two year olds in Hull for DTP/IPV/Hib, measles, mumps and rubella (MMR), Hib/MenC booster and PCV booster were 98%, 95%, 95%, 95% respectively. Immunisation rates among five year olds for Hib/MenC (booster), MMR 1st dose, MMR 2nd dose were 94%, 97% and 93% respectively. All uptake rates were higher than England and the average of 10 comparator areas. The human papillomavirus (HPV) types 16 and 18 uptake rate for young girls in Hull in 2015/16 was 79% for one dose and 73% for two doses (considerably lower than England at 87% and 85% respectively). From the Child Health Profile 2017 [19], in 2016, 87% of children in care were up-to-date with their immunisations which was the same as England. Despite overall high rates in Hull, previous local analysis also showed relatively large variations at ward and GP practice level among the uptake rates for these childhood immunisations [205].

From the Public Health Outcomes Framework dataset [27], during 2015/16, vaccination rates against influenza in Hull was 71% among those aged 65+ years (England 71%) and 43% among at-risk groups (England 45%). For 2015/16, among at-risk groups in Hull 76% on coronary heart disease registers, 72% on stroke and transient ischaemic attack registers, 73% on diabetes registers and 75% on chronic obstructive pulmonary disease registers had received the influenza vaccine including 'exceptions' (see QOF in the JSNA Glossary) [206]. The vaccination uptake rates against influenza among 2-4 year olds was 31% in Hull lower than England (38%) [27]. The pneumococcal polysaccharide vaccine (PPV) uptake rate in Hull among those aged 65+ years in 2016/17 was 72%, higher than England (70%) [27]. For 2016/17, influenza vaccination rates among pregnant women were similar in Hull to England for all pregnant women (43.7% versus 44.9%) but lower in Hull compared to England among pregnant women who were within a clinical risk group (50.8% versus 58.7%) [207]. Seven in ten pregnant women were vaccinated against pertussis (whooping cough) [208] similar to England (Hull ranked 120th out of 212).

The uptake rate for the vaccine against shingles given to 70 year olds was slightly lower in Hull (52%) compared to England (55%) for 2015/16 [27].

What are the strategic needs?

It is necessary to have a relatively high uptake rate particularly for contagious diseases that are easily passed from one person to another, particularly for children who socialise much more closely and are more likely to pass the disease to another child or a parent.

Whilst rates are relatively high and generally higher than the national average among children, there are relatively large variations in uptake rates within primary care practices, perhaps associated with the characteristics of the patients within those practices. Furthermore, the rates in Hull are lower than the national average of young girls offered the HPV, at risk populations who are offered the influenza vaccine and among those aged 65+ years. It may be useful to work with practices with relatively low uptake rates to improve their rates, and undertake some local work to improve the rates among teenagers, in maternity, among at risk populations and in older people.

This 2018 JSNA section on Vaccinations and Immunisations (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Vaccinations and Immunisations (107 pages)

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Schools and Educational Attainment

What’s the issue?

“Good education improves career prospects, raises aspirations, and gives people more financial control over their lives. Poor education and training, and low educational attainment can affect confidence, aspirations, and increase the risk of lifelong unemployment, benefit dependency or low paid employment” [209]. These factors have a strong influence on health and wellbeing. Children (and adults) with low confidence and aspirations, and with low educational attainment are more likely to make poor choices in their lives, are less likely to achieve well-paid satisfying regular employment, have poor resilience, and increase the likelihood of poor health and wellbeing.

Following the Children and Families Act 2014, children and young people (under the age of 25 years) who have special educational needs may have an Education, Health and Care (EHC) plan, developed by all professionals and the family working together, to address all needs that a child or young person has within education, health and care. Prior to the Act, children were on School Action, School Action Plus or have SEN statements (three classifications in order of severity of additional need requirements). Within the Act, SEN Support replaces School Action and School Action Plus (in schools) and Early Years Action and Early Years Action Plus (in early years).

“Literacy is the combination of reading, writing, speaking and listening skills we all need to fulfil our potential. These life skills are essential to the happiness, health and wealth of individuals and society” [210]. In England, 15% of working-age adults struggle with literacy with their literacy below levels expected of an eleven year old, but this is 26% among people living in most deprived 25% of areas nationally (and only 5% among those living in least deprived 25% of areas) [211]. "Concerns over staff literacy are widespread. Of employers who rate the competency of their low-skilled staff as poor or satisfactory, over half report problems with literacy [212]. Men and women with poor literacy are less likely to be in full-time employment at the age of thirty, and poor literacy skills can also be a serious barrier to progressing once in employment with 63% of men and 75% of women with very low literacy skills having never received a promotion [213]. There are too many adults who lack basic literacy skills" [210]. “Whilst 92% of the British public say literacy is vital to the economy, and essential for getting a good job [214], a quarter of children and young people do not recognise a link between reading and success [215]” [210]. Fourteen percent of children and young people in lower income homes rarely or never read their books for pleasure [216]. One in five parents easily find the opportunity to read to their children, with the rest struggling to read to their children due to fatigue and busy lifestyles [210]. Marmot in his strategic review of health inequalities in England post-2010 [191] stated that “Parental involvement in their child's reading has been found to be the most important determinant of language and emergent literacy” [192].

A high percentage of the working-age population in England have poor numeracy. Overall, 49% have numeracy skills below the expected levels of an eleven year old, but this is 35% among those with an Index of Multiple Deprivation (IMD) of 0-9 (least deprived 25% of areas) and 62% and 72% among those with an IMD score 30-39 and 40+ (combined most deprived 25%) [211].

Among working-age adults who live in areas with an IMD score of 50+ (most deprived 7% of areas of England), 64%, 53% and 62% are at Level 2 (see the JSNA Glossary) or below in relation to word processing, email and spreadsheets respectively (28%, 20% and 28% among those with a IMD score of 1-9) [211].

What’s our situation?

From the local Young People Health and Lifestyle Survey 2016 [107], 9% of pupils had no books and 26% had very few books (1-10 books) in their home, with a further 31% having one shelf of books (11-50 books) in their home. This differed by deprivation with 42% of pupils living in the most deprived fifth of areas of Hull having no or very few books compared to 27% of pupils living in the least deprived fifth of areas of the city.

In 2017, 1,510 of the city's two year old children benefitted from funded early education. This equated to 842% of the city's two year old population and represented a higher rate than that seen across the Yorkshire and Humber region overall (76%), and nationally (69%) and had increased from 72% in 2015.

The baseline data for children entering school shows in September 2017 only 38.6% of children entered the reception year at the age and stage of development which is typically expected for their age which was higher than in September 2015 (35.2%).

For 2016/17, 65% of children in Hull (57% of boys and 74% of girls) achieved good development at the end of reception year compared to 71% for England, although among children eligible for free school meals the percentages in Hull only slightly lower than England (53% versus 56%) [27]. From analysis of local data for 2014/15 [28], the percentages varied from 51% in Myton ward to 76% in Beverley ward. There was a strong association with deprivation and with ethnicity (even after the effect of deprivation had been taking into account). In 2015/16, among the 38,503 children attending Hull mainstream state-maintained primary or secondary schools, 1,337 (3.5%) had Special Educational Needs (SEN) Statements or an Education, Health and Care (EHC) plan (3.2% for England), and a further 5,454 (14.2%) required SEN support (11.5% for England) [22]. There are a further 598 pupils attending special schools in Hull, although not all of these pupils will live in Hull. For 4,336 (11.3%) of pupils, English was not their first language and 36.2% of pupils had been eligible for free school meals at some point in the last six years (England 23.9%). For 2015/16, the percentage of half-days missed (authorised and unauthorised absence) by primary (4.3%), secondary (5.4%) and special school pupils (8.2%) was higher than England for primary and secondary but not for special schools (4.0%, 5.2% and 9.1% respectively) with 9.8%, 14.7% and 25.8% of pupils from primary, secondary and special schools respectively persistently absent (missing 10% or more of all half-day sessions) which was also higher than England for primary and secondary schools, but not for special schools (8.2%, 13.1% and 26.9% respectively) [22]. For 2015/16, 46.3% of students in Hull achieved five or more GCSEs at grades A-C which included English and mathematics, and just over half achieved GCSEs at grades A-C in both English and mathematics (51.1%), but these percentages were 59.3% and 53.5% respectively for maintained schools in England [22].

Almost twice as many adults (27.4%) in England were qualified to degree level or higher compared to Hull (15.2%), and half as many again people in Hull (31.7%) had no qualifications compared to England (22.5%) [16, 17]. From the local adult Health and Lifestyle Survey 2011-12 [83], large differences in the highest educational attainment were evident across the wards in Hull.

What are the strategic needs?

Children potentially requiring additional support should be assessed as quickly as possible as early help gives rise to better outcomes. Children with an EHC plan or in receipt of SEN support need to have clear, comprehensive, integrated plans drawn up as soon as possible, with all professionals and the family working together to give the child the best possible care and support.

Hull’s Early Help and Priorities Family Strategy 2015-2020 (see the JSNA Glossary) aims to identify individuals and families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in an coordinated way [119].

As a good education is very important for future health and wellbeing, it is essential that children are ready for school, and children and young people are able to maximise their achievements whilst at school, college and university, so that they can have good employment prospects.

There should also be promotion of physical and mental wellbeing across all educational settings. Hull was one of the places awarded funds from the Big Lottery Fund for HeadStart project. This programme aims to enable children and young people to have positive mental health and wellbeing, thrive in their ‘communities’, and be able to ‘bounce back’ from life’s challenges. The programme is running in a number of schools in Hull.

Everybody should have the opportunity to improve their employment and life choices through increased education, training and knowledge.

This 2018 JSNA section on Schools and Educational Attainment (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Deprivation and Associated Measures (243 pages)

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Under 18 Conceptions

What’s the issue?

Teenage pregnancy is a complex social issue with a number of contributing risk factors including living in poverty, low educational attainment, absenteeism, not being in education, employment or training (NEET), involvement of social care, low self-esteem, early sexual activity and poor contraception use. There are also disproportionately poor outcomes for those who do become teenage parents. At age 30, teenage mothers are 22% more likely to be living in poverty and 20% more likely to have no qualifications than mothers giving birth aged 24 or over and are much less likely to be employed or living with a partner [217, 218]. There is a growing recognition that socio-economic disadvantage can be both a cause and a consequence of teenage parenthood [219].

What’s our situation?

Between 1998 and 2015, there has been a 55% reduction in the under 18 conception rate from 84.6 to 38.4 per 1,000 women aged 15-17 years (from 381 to 150 conceptions), which is similar to decreases elsewhere [27, 117, 181]. The current under 18 conception rate is considerably higher than England (20.8) and the average of the 10 comparators areas (29.6). The reduction in Hull occurred across both births and terminations with births reducing from 57.3 to 21.8 and terminations from 27.3 to 16.6 per 1,000 women aged 15-17 years [220]. As well as a reduction in the overall numbers in Hull, the young people who do become pregnant do so later in their teens. In 2015, 43.3% of conceptions led to a termination in Hull compared to 51.2% for England [181]. In 2015, there were 150 pregnancies among the 3,904 women aged 15-17 years in Hull [27, 181], resulting in 85 under 18s giving birth [181]. The percentage of births to under 18s in Hull has reduced from 2.8% of all births (102 out of 3,661) in 2010/11 to 1.3% (43 out of 3,432) in 2015/16 [181].

Between 2009 and 2015, there has been a 48% reduction in the under 16 conception rate from 12.6 to 6.5 per 1,000 women aged 13-15 years, which is virtually identical to the reduction in England (49%) [27, 117, 181], although the under 16 conception rate in Hull is more than double that of England (3.7) and higher than the average of 10 comparators (5.9). The termination rate was slightly higher in the under 16s in Hull (67% for 2015) compared to England (60%) and had increased considerably in Hull since 2009 when it was 50% [220]. In 2015, there were 34 pregnancies among the 3,742 women aged 13-15 years in Hull [27, 117, 181].

What are the strategic needs?

To have sustained reductions in the under 18 conception rate, work needs to continue with the momentum maintained ("any complacency now and we will see a knock-on effect in years to come" [221]). Research and evidence based practice has shown that this issue cannot be addressed through a single intervention or service as the majority of pregnancies are unplanned [218, 219, 222, 223, 224]. Instead it requires a consistent and co-ordinated partnership approach at a strategic and operational level across a range of services and providers (including schools, health workers, youth workers, social care and voluntary sector services) to address several key issues including sex and relationship education (SRE), workforce development, improved access to contraception, work with boys and young men as well as young women, and support for parents on discussing sex and relationships. The dual message of delaying early sexual activity while providing accurate information about contraception and safer sex is most effective in supporting young people [223]. There should be consistency of SRE delivery across schools, and this represents a challenge with the increasing focus on academic achievements and the ongoing pressures on the curriculum to cover a wide range of issues under the Personal, Social and Health Education banner despite its lack of statutory status.

Hull's Early Help and Priorities Family Strategy 2015-2020 (see the JSNA Glossary) aims to identify individuals and families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver support in an coordinated way [119]. This partnership approach to reduce risks and build resilience, along with effective use of local data and performance management is vital. In addition such an approach will ensure that areas with the highest rates/groups of young people most at risk are targeted and their needs met.

This 2018 JSNA section on Under 18 Conceptions (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Sexual Health (97 pages)

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