Findings

Recommendations

Local Authority

Hospital Trusts

Primary Care

Community Health Services

Integrated Care Board

Place Based Partnerships*

Pre-conception

Although pre-conception health was not explored fully in this JSNA the evidence clearly shows tackling health inequalities such as smoking and obesity before pregnancy will improve outcomes for babies.

Around 30% of women in Nottinghamshire do not access maternity care before 10 weeks.

In order to improve pregnancy outcomes there needs to be a focus on pre-conception health. A task and finish group bringing together members of the best start system, contraception and sexual health services and primary care will trial evidence-based approaches to improving preconception health.

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Reach

Parents and carers told us they valued the services and support available to them.

Parents and carers told us they want to access services as early as possible and want easy ways to find out about services.

The percentage of deliveries to women from ethnic minority groups is increasing in Nottinghamshire.

Fathers told us they wanted more information and support. Evidence shows that father inclusivity can have a positive impact on families.

Families value and use community assets such as green spaces, community venues and libraries.

A greater focus on early access to services is required that ensures people receive antenatal care early and that all services for 0-2 years can be accessed before needs escalate, including

- commissioners and providers continuing to build on progress to ensure early referral to Family Hubs

- continued promotion and development of the Best Start for life offer

- development of a digital resource hub for parents and carers

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Building on national and local campaigns and incorporating the virtual Family Hub, the reach of current messaging needs to be improved. This needs to address barriers to information such as digital exclusion, cultural difference and language barriers.

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The best start system develops an approach to father inclusivity, including consideration of teenage fathers. This must be driven by fathers and have a focus on frontline delivery.

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Strategic approach

Evidence shows that support for Parent-Infant relationships has a significant impact on children’s outcomes. Children who have good early relationships start early education and school best equipped to be able to make friends and learn. Locally there is not enough capacity to meet the need based on modelling data.

Of the babies who received PIRi support a higher percentage scored above the threshold in the ASQ-SE at their 12-month review.

Mental health conditions in the perinatal period affect around 1 in 4 women locally. Evidence shows fathers will also be affected.

Around 20% of children did not achieve the expected level of development in all five areas of ASQ-3. Communication is the primary need.

Evidence shows the impact a positive home learning environment can have on a child’s early development skills.

Across the Best Start system there needs to be more capacity for and a greater focus on Parent-Infant relationship support.

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Increase access to services that support parental mental health and emotional wellbeing by improving integrated care pathways.

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Earlier action is needed to support healthy child development across the 1001 days with a particular focus on communication. By strengthening Parent-Infant interactions and improving the quality of the home environment.

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The refreshed Best Start Strategy and other relevant strategies need to focus on

·         Parental mental health

·         Parent Infant Relationships

·         Children’s early development including speech, language and communication

·         Home learning

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Health inequalities

Some districts experience higher levels of deprivation which evidence shows can have a significant impact on babies’ outcomes. These districts are also the areas with the highest numbers of births across the county.

There is evidence for the impact of continuity of carer in supporting women and babies and reducing health inequalities.

There is wide variation in teenage pregnancy rates across districts.

Many of the districts which experience high levels of deprivation are also experiencing higher smoking rates, higher rate of babies born with low birth weight, higher teenage pregnancy rates, lower breastfeeding rates, lower vaccination rates, and lower results in ASQ-3.

Between 26%-33% of pregnant people at 15 weeks have a BMI higher than 30. 

The number of women smoking at the time of delivery is decreasing but is still worse than England.

The number of babies being breastfed is increasing but remains lower than England. 

Vaccination coverage rates in Nottinghamshire are between 90%-95% and there is a general decrease in vaccination coverage over time reflecting national trends.

Almost 8% of 2-2.5years did not achieve expected level of development for gross motor skills.

Action needs to be taken to improve health and wellbeing across the perinatal period. The focus of this work will need to include

·         Black and brown skinned women

• Lower socio-economic groups
• Teenage pregnancy
• Those with higher BMI’s
• Those with multiple disadvantages

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The best start system draws upon the experience and learning of Place Based Partnerships and community level working to ensure positive change across districts such as Ashfield, Mansfield and Bassetlaw.

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An integrated healthy weight in pregnancy pathway needs to be developed to ensure women can access services promptly.

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The commitments in the Infant Feeding Strategy need to be taken forwards in order to improve breastfeeding rates and reduce inequality.

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The reduction in vaccine uptake is addressed through developing a better understanding of vaccine hesitancy in parents.

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More work is required to understand why some children are not achieving the expected level of development in gross motor skills.

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Continue to reduce smoking in pregnancy in line with local and national initiatives.

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Data

The uptake of the 2-2.5years development review is lower than the 12-month development review.

Limited data is collected about fathers and their access to services.

There is limited data relating to healthy weight in pregnancy.

There are challenges with the quality of data reported into Maternity Services data set and Community Services data set.

There is no local data reflecting parent-infant relationships.

There is limited local data on smoking in at time of delivery at district level.

Analysis of ASQ-3 and ASQ-SE data at 12 months will assist with early identification of needs.

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Work with Integrated Care Board, Family Hubs, Healthy Family Teams, Maternity services, and commissioners to establish a local Best Start Data Dashboard.

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Explore ways to improve the quality of data reported in Maternity Services data set and Community Services data set.

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Explore opportunities for data collection in relation to parent-infant relationships.

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Explore opportunities to improve data collection in relation to smoking in pregnancy.

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