North Wales Health Improvement Review External
Stakeholder Engagement Events – Summary of Feedback
Early Years
Needs & Issues
Access – Health services; Isolated communities; fresh /right foods - Including
food banks; Physical activity in pregnancy and new mothers; Immunisation;
Access to ‘health start’; Fibre – constipation huge issue; Nutrition pathway; Oral
health; Rurality issues; Opportunities - physical activity; Peer support for
breastfeeding; Breastfeeding friendly premises; Swimming, is cost a barrier?;
Social Inclusion & Inequities - Poor access to additional support; Need for
nutrition, warmth care, shelter& safety; Breastfeeding; Poverty; Poor mental
health; Peer pressure/ support; Parental substance use; Abusive controlling
relationships; Teenage pregnancy; Breastfeeding - Esp. sustainability from
initiation – where behaviour changes. N.B: B/F is cost saving for NHS (avoided
admissions; protective for breast ca); High rates obesity in Wales and low rates
B/F. difference in s/econ groups. ; Processed foods, fluid intake, fruit and
vegetable intake; Maternal smoking and exposure to second hand smoke in
homes; Children obesity – type 2 DM being seen in services; Physical activity;
Transient populations; Coastal strip – caravan parks bedsits, short contract;
Asylum seekers in Wrexham; Overcrowding/multiple occupancy – substandard
housing; Issues emerging changes to benefit system; Domestic violence; Fear of
letting children out to play; Too much time on game consoles;
Service delivery - Flying start/generic HV service; Pre-conceptual care; Use of
new technology; Signposting to services; Smoking /alcohol use in pregnancy;
Routine rituals from birth; Overweight/obesity in pregnant women - impacts on
child health; Iron deficiency - esp 2/3 year olds linked to weaning. Big impact on
development; Raised lipids in young children; Targeting to families who need the
help most; Safeguarding issues - particularly issues in pockets; Need more
continuity; Flexible approaches of working; Capacity issues; Clearly defining who
does what; Need for early intervention; BMI > 30 preparing women for a safe
pregnancy; Need to identify women with post natal depression; Strengthening
links between health and leisure; Improve links between Stop Smoking Wales –
leisure centres/services; Tackle mental well being; Language development
issues;
Communications - Quality of information/delivery approach; Engaging parents
(especially in rural areas) – birth – preschool; Consistency of information;
Promotion of mental parental wellbeing; Confusion and lack of clarity re. Vitamin
administration & distribution; Language - Welsh/ English/ Polish/ Chinese and
Asian communities; Marketing of what we do. e.g. aqua aerobics, buggy walks ,
baby massage, yoga; Marketing of information – family information service;
Making links – better communication; Importance to reach seldom heard
groups; Signpost to services – e.g. sexual health services; Too much time on
game consoles;
Resources - Better support for fathers; Sustainability/long term support;
Welfare reform; Support for breastfeeding mothers (esp younger women) Needs investment and consistency; Nutrients – folid acid and vitamin D; Poor
nutrition and supplementation; Discontinuation of birth books. Risk regarding
online provision; Creative play- Reaches a lot of children at one time; Free; Long
acting reversible contraceptives (empower to choose);
Training & Education – Parenting; Cooking advice; Basic food knowledge;
Preparation for parenting inc SRE and special needs children – especially in
school; Teeth, hands, snack, exercise, sleep , rewards and treats – basic
messages and boundary setting; “Parental modelling” - impact of parents health
behaviours on children (also child minders/nurseries); Consistency in staff
training across N Wales – differential; Issue regarding education (of
professionals) accessibility of Folic acid & Vit. D; Impact of weaning on future
foods preferences of children; Overall significance of early years in terms of
influencing future behaviours and also impact on physiology for life time; Sign
language development; Front line training for staff - Tobacco issues / alcohol;
Current Services
Lacking - Challenge with getting staff (HVs/SNS, midwifes) released to
attend training delivered by dietetic specialists; Vehicle for delivery of
messages reinforcement, accessibility (variety of settings incl playgroups)
Available - Change for life and Start 4 Life; Tiny tums; Breastfeeding peer
support groups inc MA’s BARS, La Leche Legue; Health Visitors; Parenting
programmes inc. Language and play, Numeracy and play; Cooking bus;
Food dudes - nursery, pre-school; SMATS/youth offending team; Books
on prescription; Libraries; Leisure services; Substance misuse midwife;
Core pathways e.g. obesity, mental illness; Food coops; Healthy start
vitamins; Appetite for life – preparing young mums; Fresh start- Smoke
free cars/homes.; Radio advertising; Smoking cessation; Brief
intervention training; Groundwork/ BTCW/wider environment initiatives;
BEAT relevant to eating disorders; Early entitlement e.g. toy libraries;
Generic ante natal / post natal services; Mum and toddler groups;
Breastfeeding friendly premises; UK BFI for hospitals and communications
services; Milk provision in pre-school settings; School clinics; Dietetic
support (NHS) – esp in relation to healthy and safe weight for pregnancy;
Adaptation /refocusing of dietetic balance between prevention and clinical
treatment; Families first; Flying Start; Healthy start (vitamins focus);
Pregnancy and birth to Five books; Dietetic capacity grant; Social
services; Team around the family; Family information services; Housing;
Integrated family support services; Local voluntary services; Barnados;
Home start; Dietetics – community dietician; GPs; Family centres;
Communities first; NERS – diabetics , coronary heart disease etc; Looked
after children strategy; Designed to smile – community dental; Stop
Smoking Wales; Healthy and sustainable pre-school schemes; Incredible
years (parenting); Community parents (mentoring); Fire and rescue
service; Community safety partnerships; Domestic violence workers;
Women Aid; Genesis; Physiotherapy; Paediatric OTs; Specialist nurses;
Aqua aerobics/pram pushes; Mother and baby swims; Early intervention
CAHMS;; Children’s Integrated Disability Service; Child Development
Service; Daffodil – support for families with a child with disability; Teen
mum – parent groups, educational support/ CYFLE; Training for foster
carers;
Potential – Food Dudes special schools (Bangor University) Not yet in
Wales; Family centres as a focus for delivery of whole range of health
improvement; Activities - essential to ensure they are sustained and
strengthened and mainstreamed (issue re. Awareness of the existence);
Importance of dieticians in role of “translating” evidence into useable
material/information; Importance of HSPS scheme – early days;
Wordle
Opportunities
Partnership - Strength links with agencies that can support family
learning; Cross sector approach; Grass roots collaboration – cooperation;
Structures to be better - work together; Clarity of roles / avoiding
duplication/ identifying gaps;
Good Practice - National exercise referral scheme; Change for life very
useful – inc Start for life; Physical activity & nutrition Network very useful
for access to information, events etc.; Sexual health network; C-Card and
teenage pregnancy work including for vulnerable groups e.g Looked After
Children; Capture learning from “Bump into Action”; Sharing good
practice and sharing what doesn’t work in a supportive way; Project –
community roots - opportunity for formal networking; Careers Wales;
Potential Development - Ongoing support for parents that are not able to
access targeted services; Further investment in HSPSS (Health and
sustainable pre-school scheme); Massive opportunity to influence family
health; Expand healthy schools & pre-school scheme to support parents;
Develop approaches to improve maternal parental health literacy;
Strength pre-conceptual advice; More social marketing; Consider use of
social media/technology apps; Mental Health Promotion network needs
changing. It is too focused on prevention and intervention for mental
illness. Greater focus on mental well being needed; Extension of Start 4
Life to preconception and pregnancy (opportunity to take advantage of
work already ongoing in England); Adopt “Healthy Child Programme” from
England – Pathway and evidence based interviews from pregnancy to 18
structured and universal; Development of effective smoking in pregnancy
service across Wales; Work to clarify and simplify access to vitamins esp
folic acid including targeted social marketing campaign for pregnancy and
early years; Standardisation/accreditation of training and delivery of
intervention in Flying Start; NERS – specialist training – maternal weight;
Locality leadership teams – extending work to early years; Antenatal
classes – timings, targeting specific groups; Use of “drop in”; Strengthen
parenting services and support for general population; Research officer –
sharing what works. Evidence base; Brokerage schemes; Cooking skills;
Embedding nutrition in education; Lower case loads of HVs to enable to
do preventative work influencing GPs;
Conditions & Provisos - More support for generic HVs; Increase
flexibility of approach/ support e.g. childcare; Ensure relevant to
individual circumstance and needs; Pregnancy and Birth to 5 books. E.g
CD/book/download? : Who is using them? Are they accessible? What
other information is needed and how to disseminate it? Need to consult
with parents from all groups. Improved surveillance of maternal and child
health (particular relevance to breastfeeding); Invest in and protect
universal services (M/W, HVs, SNs, dietetics, other therapies) to deliver
prevention and fairly intervention; Issues particularly regarding how to
support and address needs of under 5’s already overweight/obese; Need
to improve confidence of staff to raise lack of parental recognition of
weight issues in the children. Staff weight issues – work place
importance; Are priorities embedded within programmes?; Weaning information advice support - Service stretched; Sustainability – funding avoid small pots for short periods; Efficient and relevant governance of
projects/schemes;
Wordle
General Summary Points
The needs and issues identified against the Early Years health improvement
agenda fall under six key headings:
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Access
Resources
Communications
Training & Education
Service Delivery
Social Inclusion and Inequalities
Unsurprisingly the role of parents and the importance of parental support appear
to be the main issues identified by respondents. Though some access issues
were identified, most of the concerns raised related to social and economic
factors that have such negative impacts on families, particularly amongst those
in less affluent communities. There was a particular problem perceived for
travellers and asylum seekers in North Wales. Mental wellbeing, nutrition and
obesity were specific areas of health concern and the recognition that there
should be greater integration of services to tackle issues that crossed
professional boundaries and responsibilities. There were suggestions on
additional training support both for parents and for professionals working with
families.
In terms of current services there was a considerable range identified supporting
this agenda with relatively few gaps. A variety of opportunities were proposed
including further developments of the Healthy Schools initiative, improved social
marketing and greater integration of services.
Synthesised Wordle of key terms identified across all questions.