The Scrutiny Support Officer submitted a report the purpose of which was to introduce the Director of Public Health and Heidi Douglas, Speciality Registrar Public Health on the topic of children with complex needs with particular regard to issues around low birth weight.
The introductory report also included the following draft terms of reference for the scrutiny investigation:-
1. To investigate the key indicators of child health in Middlesbrough and specifically, what they say about child health in Middlesbrough.
2.To investigate the prevalence of complex needs amongst children in Middlesbrough.
3.To investigate the current range of services available for children with complex needs in Middlesbrough.
4.To investigate whether there are any gaps in service provision for children with complex needs.
5.To explore the future challenges for services for children with complex needs.
6.To investigate the extent to which the local health and social care economy co-ordinates its efforts, in the provision of services to children with complex needs and their families.
The Chair welcomed Heidi Douglas to the meeting who gave a PowerPoint presentation in addition to a detailed report previously circulated which provided an overview of current data relating to low birth weight babies (LBW) and preventable environmental factors that contributed to poor maternal health and LBW babies.
LBW was a major factor in infant mortality and had serious consequences for child health both in early years and later life. It was defined as births as being under 2,500g.
The Panel was advised that LBW babies were more common in the following circumstances:-
Babies born to mothers under the age of 20 and over the age of 40;
Babies born to mothers living in deprived areas or mothers with low socio-economic status;
Babies born to lone mothers;
Babies born to mothers outside of the UK especially to some black and minority ethnic groups.
International comparisons suggested that factors beyond genetic constraints were responsible for differences in birth weight within populations and that birth weight distributions could potentially be altered by public health interventions.
Smoking during pregnancy was reported as the major modifiable risk factor contributing to LBW and preterm delivery. Statistical information was provided which illustrated the association between increased social and economic disadvantage and higher levels of smoking amongst women with young children.
The risk factors which contributed to LBW included substance misuse; depression and lows levels of social support; micronutrients low dietary intake; and a lower uptake of prenatal care.
Middlesbroughs proportion of LBW children (9.5%) was reported as approximately 1% above the Tees Valley average and 2% above the national average in 2010. Current performance indicators for 2012 for Middlesbrough showed that the numbers of LBW babies continued to rise (10.1%).
In Middlesbrough between 1991 and 2004 the average rates for LBW children ranged from a low 2.4% in Nunthorpe to19.9% in relation to Pallister Park.
A recent analysis of the pregnant smoking population in Middlesbrough using Mosaic confirmed that such a profile was replicated in Middlesbrough maternal smoking population. The prevalence of smoking in pregnancy in Middlesbrough was reported as 27.2% which was double the national average in England of 13.5% and significantly higher that the regional average of 21.1%. The distribution of smoking prevalence in Middlesbrough mirrored the pattern of deprivation with the deprived wards having higher percentage of smokers compared to more affluent wards.
Births to women under 20 years was a known risk factor of increased likelihood of LBW children. Middlesbrough had the second highest rates of teenage conception in England. In Middlesbrough there was a strong correlation between teenage pregnancy and levels of deprivation.
Alcohol consumption of more than one unit per day during pregnancy was a risk factor for LBW disorders. Substance misuse during pregnancy was associated with a range of health problems for both the mother and baby due to a complex combination of the direct impact of drugs and other health issues and wider social and economic factors.
It was pointed out that further work was required to understand the patterns and levels of drugs and alcohol consumption during pregnancy and the current services that were in place to address such issues for pregnant women.
The report outlined current workstreams to address LBW in Middlesbrough and confirmed that the Middlesbrough Children and Young Peoples Trust Executive Board had formed a task and finish group that would oversee a number of workstreams including a maternal health needs assessment, co-ordination of maternal working groups, local and regional surveillance and social marketing.
The Health Needs Assessment would as part of its work seek to engage service providers and stakeholders to gain an understanding of services and programmes that were currently being delivered, interagency working and gaps in the current model. Given the NHS reforms the need to ensure co-ordinated efforts and collaborative working to avoid duplication was acknowledged. There was a need for robust monitoring and local surveillance systems to capture demands placed upon special care services and the nature of the complexity of the presenting cases.
AGREED as follows:-
1. That Heidi Douglas be thanked for the detailed information provided which would be incorporated into the overall review.
2. That the draft terms of reference for the scrutiny investigation as outlined be approved.